Does R25.8 require prior authorization?

No, R25.8 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R25.8` — Other abnormal involuntary movements

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
When billing a Z-code as the diagnosis, documentation must include the orthotic/prosthetic device name, date patient received the device, and date training/teaching began.
Documentation for CPT 97542 wheelchair propulsion training must relate the training to expected, attainable functional goals for the patient and/or caregiver.
Physical therapists must report patient contact time in 15-minute increments and bill using G0151 for physical therapy time reporting.

CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.
If authorized by state law, physical therapists (PTs) are allowed to perform the technical and professional components of nerve conduction studies represented by CPT codes 95907-95913 consistent with a 7A supervision designation (effective 01/01/2013).
If authorized by state law, the technical component of neuromuscular junction testing CPT 95937 (TC) with supervision designation 7A is allowable for PTs consistent with the 7A description (effective 01/01/2013).

L34635 — Botulinum Toxin Type A & Type B

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

A57474 — Billing and Coding: Botulinum Toxin Type A & Type B

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

A59808

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