Does D42.1 require prior authorization?

No, D42.1 does not require prior authorization (high confidence). Covered without prior authorization.

`D42.1`, Neoplasm of uncertain behavior of spinal meninges

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must document medical necessity including relevant history, physical examination, and results of pertinent diagnostic tests or procedures.
A hard copy computer-generated recording of the test results and the provider's interpretation must be included in the patient's record.
The somatosensory evoked potential (SEP) report must specify which nerves were tested, latencies at various testing points, and an evaluation stating whether values are normal or abnormal.
If the performing provider differs from the ordering/referring provider, the performing provider must retain copies of the test results, interpretation, and the ordering/referring provider's order for the studies.

Somatosensory testing is covered when medically reasonable and necessary and documented in the patient's medical record (relevant history, physical exam, and pertinent diagnostic test results).
Testing and interpretation are covered when ordered and/or furnished by qualified personnel who have documented training and experience in evoked potentials and electrodiagnostics per CMS guidance (accredited residency/fellowship, national certification, or accredited post-graduate training/AMA-AOA Category 1 CME).
The technical component may be furnished by a physical therapist with ABPTS certification without physician supervision, or by a certified technician under supervision consistent with the MPFSDB supervision level assigned to the CPT code (e.g., Level 21 for CPT 95925, 92526, 95927, 95938).
Intraoperative neurophysiological testing is billable only when coverage criteria and medical necessity in related LCD L34623 are met.
ESA therapy is covered to treat clinically significant anemia by elevating or maintaining red blood cell levels (as demonstrated by Hgb/Hct) to decrease anemia and reduce the need for transfusions.
End stage renal disease (ESRD) patients on dialysis with anemia (Hgb < 10.0 g/dL or Hct < 30%) are eligible for ESA therapy.

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

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