T85.820A — Fibrosis due to nervous system prosthetic devices, implants and grafts, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The claim must include the diagnosis code(s) that best describe the patient's condition for which the service was performed (valid ICD-10-CM required).
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- Medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit, relevant medical history, and results of pertinent tests/procedures.
- All services ordered or rendered to Medicare beneficiaries must be signed and dated in the medical record (signed and dated office visit record/operative report).
Key Coverage Criteria
- Speech-language pathology services are covered when they are skilled, medically necessary interventions documented in the medical record and intended to produce measurable functional improvement in communication, independence, or functional competence.
- Diagnostic tests related to speech-language pathology should be billed with the test result reported if known, or with the symptom(s) prompting the test if the result is not yet available.
- 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
6 Active Policies
A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck
A57040 — Billing and Coding: Speech-Language Pathology
A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck
L35175 — MRI and CT Scans of the Head and Neck
L37373 — MRI and CT Scans of the Head and Neck
Related Codes
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