Does E00.9 require prior authorization?

No, E00.9 does not require prior authorization (high confidence). Covered without prior authorization.

`E00.9`, Congenital iodine-deficiency syndrome, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation supporting MAC must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and be made available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
When G9 modifier is used for history of severe cardiopulmonary disease, document the clinical decision-making process and the need for additional monitoring in the medical record.

Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.
Use G9 anesthesia modifier to indicate need for MAC due to a history of severe or advanced cardiopulmonary disease when the proceduralist determines additional monitoring is required.
Use G8 anesthesia modifier for certain deep, complex, complicated, or markedly invasive surgical procedures when applied to anesthesia codes 00100, 00300, 00400, 00160, 00532, or 00920.
MAC may be appropriate for pediatric patients (Medicare-eligible and younger than 18) when documented using ICD-10-CM code T88.8XXA and clinical records justify the need for MAC.
Measurement of intra-epidermal nerve fiber density (IENFD) by skin biopsy is medically necessary for the diagnosis of small-fiber neuropathy when ALL of the following criteria are met: Individual presents with painful sensory neuropathy; and There is no history of a disorder known to predispose to painful neuropathy (e.g., diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); and Physical examination shows no evidence of findings consistent with large-f [...]
ICD-10 code listed as covered if selection criteria are met: G60.8 — Other hereditary and idiopathic neuropathies

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57361, Billing and Coding: Monitored Anesthesia Care

CIGNA-0549, Head and Neck Ultrasound

AETNA-CPB-0774, Nerve Fiber Density Measurement

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