Does E0733 require prior authorization?

Yes, E0733 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`E0733`, Transcutaneous electrical nerve stimulator for electrical stimulation of the

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Documentation that non-epileptic attacks (e.g., cardiogenic syncope, psychogenic seizures) have been ruled out.
Comprehensive presurgical evaluation documentation (inferred requirement): detailed seizure history, prior anti‑seizure medication trials and failures, seizure frequency and type.
Electroencephalography (EEG) data including scalp EEG and, when applicable, invasive/subdural recordings — documentation of seizure focus localization (inferred from multiple EEG and invasive monitoring citations).

Implantable vagus nerve stimulators are proven and medically necessary for treating epilepsy in individuals who have medically refractory seizures with failure of two or more trials of antiseizure drugs (or intolerable AED effects), are not candidates for epilepsy surgery (or have failed/refuse after shared decision making), and have no history of left or bilateral cervical vagotomy.
Transection of corpus callosum (callosotomy) — CPT 61541, covered if selection criteria are met
Cerebral hemispherectomy when all selection criteria are met, including members with unilateral multi-focal epilepsy associated with infantile hemiplegia (especially in hemimegalencephaly and Sturge-Weber disease).
Corpus callosotomy when all selection criteria are met, including members with focal to bilateral seizures (formerly known as secondarily generalized seizures).
Temporal lobectomy (including selective amygdalohippocampectomy) when all selection criteria are met, including members with focal impaired awareness seizures (formerly known as complex partial seizures) of temporal or extra-temporal origin.
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) (e.g., NeuroBlate, Visualase) as an alternative to standard surgery where criteria in section A. on epilepsy surgery are met.

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

UHC-POL-vagus-nerve-stimulation, Vagus and External Trigeminal Nerve Stimulation

AETNA-CPB-0394, Epilepsy Surgery

AETNA-CPB-0078, Learning Disabilities, Dyslexia, and Vision

AETNA-CPB-0374, Trigeminal Neuralgia: Treatments

REGENCE-DME83.14, External Trigeminal Nerve Stimulation for the Treatment of Attention Deficit Hyperactivity Disorder

UMR-POL-UMR-vagus-nerve-stimulation, Vagus and External Trigeminal Nerve Stimulation

SUREST-POL-SUREST-vagus-nerve-stimulation, Vagus and External Trigeminal Nerve Stimulation

CIGNA-0160, Electrical Stimulation Therapy and Devices in a Home Setting