Does M31.0 require prior authorization?

No, M31.0 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M31.0` — Hypersensitivity angiitis

ICD-10-CM

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation Required

Billing and coding for pulmonary stress testing must follow Local Coverage Determination (LCD) L33444; consult LCD L33444 for specific medical necessity, coding, and billing criteria.
This article provides billing, coding, or other guidelines that complement LCD L33444 rather than standalone coverage criteria.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.

Key Coverage Criteria

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis
H44.532 | Leucocoria, left eye

20 Active Policies

A57593 — Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

J05

L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J05

L35761 — Non-Invasive Peripheral Arterial Vascular Studies

J05

A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J05

Have a follow-up question?

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

Documentation and supporting information must be available to Medicare upon request.

Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

A58893 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J06

L39139 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J06

A59764 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J09

L40288 — Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

J09

L39877 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J09

A60317 — Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

J09

A59763 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J09

L40275 — Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

J12

A59766 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J12

A60314 — Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

J12

L39879 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J12

A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck

A57327 — Billing and Coding: Electrocardiograms

A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck

A56784 — Billing and Coding: Pulmonary Stress Testing

L39575 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

M31.0 — Hypersensitivity angiitis