Does E70.0 require prior authorization?

No, E70.0 does not require prior authorization (high confidence). Covered without prior authorization.

`E70.0`, Classical phenylketonuria

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For intractable tremor (Parkinson's disease or essential tremor): documentation that member does not have dementia, severe depression, cerebral atrophy, or Hoehn and Yahr stage V Parkinson's disease.
For intractable tremor: documentation that other independent diagnoses that could explain failure to respond to medical treatment have been excluded.
For essential tremor: documentation that tremor is disabling upper extremity essential tremor not responding satisfactorily to drug therapy (history of medication trials and responses).
For Parkinson's tremor/motor complications: documentation of levodopa responsiveness with clearly defined "on" periods and that motor complications cannot be managed with medication.

Aetna considers unilateral or bilateral deep brain stimulators (e.g., stimulation of the ventral intermediate thalamic nucleus, globus pallidus, and subthalamic nucleus) medically necessary durable medical equipment (DME) for the treatment of intractable tremors as a consequence of Parkinson's disease or essential tremor when all of the following criteria are met:
- Member does not have dementia, severe depression, cerebral atrophy, or Hoehn and Yahr stage V Parkinson's disease (see Note below)
- Member does not have other independent diagnoses that could explain the failure to respond to medical treatment
- Member suffers from disabling upper extremity essential tremor that is not responding satisfactorily to drug therapy or suffers from a disabling tremor of idiopathic Parkinson's disease that is refractory to pharmacotherapy
- There is no focal lesion of the basal ganglia (e.g., a space occupying lesion or lacunae) at the target site that would negate the result of thalamic stimulation
- There is sufficient residual motor function in the upper extremity so that it is reasonable to expect an improvement following the surgery

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

CIGNA-0136, Infant Nutritional Formula

AETNA-CPB-0181, Evoked Potential Studies

AETNA-CPB-0208, Deep Brain Stimulation

AETNA-CPB-0300, Hair Analysis

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