Does R22.1 require prior authorization?

No, R22.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R22.1` — Localized swelling, mass and lump, neck

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.
An updated and completed OASIS M2200 for the billing period must be in the patient's medical record and made available to the Medicare Administrative Contractor upon request to support medical necessity for therapy services.

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.'
Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.
Electrical stimulation (attended CPT 97032 or unattended HCPCS G0283) may be covered as part of a therapy plan of care to improve function when the nerve supply to the muscle is intact and atrophy is due to non-neurological disuse (e.g., post-casting, splinting, soft-tissue scarring).
Wheelchair management training (CPT 97542) is covered for patient and/or caregiver training in transfers and propulsion when documentation ties the training to attainable functional goals.

L35753 — Non-Invasive Cerebrovascular Studies

J05

L35498 — Removal of Benign Skin Lesions

J05

A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies

J05

A57482 — Billing and Coding: Removal of Benign Skin Lesions

J05

A56787 — Billing and Coding: Nonvascular Extremity Ultrasound

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