Does G97.52 require prior authorization?

No, G97.52 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G97.52` — Postprocedural hemorrhage of a nervous system organ or structure following other procedure

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.
This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.

Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).

A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies

J05

L35753 — Non-Invasive Cerebrovascular Studies

J05

A57064 — Billing and Coding: Duplex Scan of Lower Extremity Arteries

J09

L33667 — Duplex Scan Of Lower Extremity Arteries

J09

A52992

Ask Verity about documentation requirements, denial risks, or coverage in your state.