Does R45.86 require prior authorization?

No, R45.86 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R45.86` — Emotional lability

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.
Medical necessity for the diagnostic assessment, psychological/neuropsychological tests, and psychotherapy must be documented in the medical record.

Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
Diagnostic psychiatric interview is indicated for initial or periodic diagnostic evaluation of a patient with suspected or diagnosed psychiatric illness.
Additional diagnostic evaluation may be medically reasonable and necessary for the same patient when a new episode of illness occurs, there is an admission or readmission to inpatient status due to complications, or when re-evaluation is required to address a new referral question.
Interactive diagnostic procedures (e.g., modified interview techniques) are indicated when a patient’s ability to communicate is impaired by expressive or receptive language impairment (hearing loss, deaf mutism, aphasia), language barrier, or lack of mental development (childhood).

A57130 — Billing and Coding: Psychiatric Codes

J12

L35101 — Psychiatric Codes

J12

AETNA-CPB-0739 — Functional Magnetic Resonance Imaging

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