Does R68.84 require prior authorization?

No, R68.84 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R68.84` — Jaw pain

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name, dates of service), and be available to the contractor upon request.
The medical record must identify the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Medical records must be maintained and available upon request; every page must be legible and include patient identification (e.g., full name, dates of service) and identify the physician or non-physician practitioner responsible for care.

Regional or local nerve blocks performed as part of an operative procedure (e.g., adjunct to or sole means of regional/local anesthesia for the procedure) are not affected by this non-coverage policy and may be billed as anesthesia for the operative procedure.
Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Stress testing (exercise or pharmacological, including stress echocardiography) is covered when the results will potentially affect the patient’s treatment plan.

A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

A57327 — Billing and Coding: Electrocardiograms

A59840 — Billing and Coding: Magnetic Resonance Imaging of the Head and Neck

AETNA-CPB-0113 — Botulinum Toxin

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