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30.2.5 Anterior Temporal Lobectomy
Procedure code 61538 is a benefit for surgery or assistant surgery when billed for diagnosis codes 34540, Partial epilepsy, without mention of intractable epilepsy and 34541, Partial epilepsy, with intractable epilepsy. The request for prior authorization must:
• Indicate whether a diagnostic workup has been completed.
•Document medical treatment regimens tried to date.
•Document the drug treatment regimens, including the name(s) of the drug(s), previously taken to maximum acceptable levels without ability to control seizure activity.
•Document that seizures have temporal focus.
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