Does B50.0 require prior authorization?

No, B50.0 does not require prior authorization (high confidence). Covered without prior authorization.

`B50.0`, Plasmodium falciparum malaria with cerebral complications

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim.
The diagnosis code(s) submitted must accurately and specifically describe the patient's condition for which the visual electrophysiology test was performed.
Follow applicable NCCI and OPPS billing requirements and edits prior to claim submission as coding may be affected by these edits.
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD.

Electroretinography (ERG) is covered when medically necessary and consistent with locally accepted standards of practice and is supported by an appropriate ICD-10-CM diagnosis that best describes the patient's condition.
For diagnostic ERG tests, report the test result if known; if the result is not known at time of billing, report the symptoms that prompted the performance of the test.
Fuchs' endothelial dystrophy
Persons who recently had laser iridotomy for the treatment of narrow angle glaucoma (also known as acute angle-closure glaucoma or closed-angle glaucoma)
Anatomical narrow angles
Bullous keratopathy

CGS-J15-L38992, Electroretinography (ERG)

J15

CGS-J18-L38992, Electroretinography (ERG)

J18

A57599, Billing and Coding: Visual Electrophysiology Testing

WPS-J5-L37015, Visual Electrophysiology Testing

NGS-J6-L36831

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