Does A83.5 require prior authorization?

No, A83.5 does not require prior authorization (high confidence). Covered without prior authorization.

`A83.5`, California encephalitis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
For claims using CPT codes not listed in this article, submit supporting clinical and billing documentation for individual review.
A claim for the prior routine EEG must have been submitted to Medicare with a date of service within 1 year of the ambulatory EEG date of service; documentation/proof of that prior claim must be available.
When billing only the professional or the technical component, documentation must indicate which component was provided and support billing of that single component.

Ambulatory continuous EEG is covered only if a prior routine “resting” EEG was performed before the ambulatory EEG.
Routine EEGs covered under this policy are those described by CPT codes 95812, 95813, 95816, 95819, or 95822.
A routine EEG is defined as a recording of less than a 24-hour continuous duration.
Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
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.

NOVITAS-JH-L34975, Neurophysiology Evoked Potentials (NEPs)

A56773, Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

NOVITAS-JL-L34975, Neurophysiology Evoked Potentials (NEPs)

A57206, Billing and Coding: Lumbar MRI

A56771, Billing and Coding: Special Electroencephalography

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