I63.411 — Cerebral infarction due to embolism of right middle cerebral artery
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and be made available to the contractor upon request.
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Providers must comply with any additional documentation, prior authorization, or provider-qualification requirements specified in the referenced LCDs and Billing and Coding Articles.
Key Coverage Criteria
- Billing and coding for Category III codes is allowed only when the service meets the coverage indications, limitations, and medical necessity criteria described in LCD L35490 and the performing physician (MD/DO) meets all criteria in that LCD and this Billing and Coding Article.
- CPT 0446T, 0447T, and 0448T (creation/removal/replacement of implantable interstitial glucose sensor) are billed and covered only per LCD L38686 and Billing and Coding Article A58213 when all criteria in that LCD/article are met.
- CPT 0421T and HCPCS C2596 (transurethral waterjet ablation of the prostate and associated probe) are billed and covered only per LCD L38682 and Billing and Coding Article A58209 when all criteria in that LCD/article are met.
- Electrocardiographic (EKG/ECG) monitoring (Holter or real-time) billing and coverage follow LCD L34636 and Billing and Coding Article A57476 and are allowed when those LCD/article criteria are met.
- Holter monitoring (CPT 93224-93227) is covered for up to 48 hours of continuous recording when progress notes document medical necessity.
- Wearable external mobile cardiac telemetry (CPT 93228 professional, 93229 technical) is covered as one unit per course of treatment that includes up to 30 consecutive days of cardiac monitoring when the documented services (hook-up, transmission, analysis, daily reports, equipment and supplies, and physician review) are provided.
20 Active Policies
L35121 — Coronary Computed Tomography Angiography (CCTA)
J05
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
L34636 — Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)
J05
L38839 — Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
J05
Related Codes
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