Does E71.40 require prior authorization?

No, E71.40 does not require prior authorization (high confidence). Covered without prior authorization.

`E71.40`, Disorder of carnitine metabolism, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
This Clinical Policy Bulletin addresses nutritional support.
Aetna considers enteral tube feedings medically necessary when the member has either (a) permanent non-function or disease of the structures that normally permit food to reach the small bowel; or (b) disease of the small bowel that impairs digestion and absorption of an oral diet, either of which requires tube feedings to provide sufficient nutrients to maintain weight and strength commensurate with the member's overall health status.
The member's condition could be either an anatomic abnormality (e.g., obstruction due to head and neck cancer or reconstructive surgery, etc.) or a motility disorder (e.g., severe dysphagia following a stroke, neuromuscular or disease of the central nervous system that interferes with the ability to chew or swallow, etc.).
Calorically dense formulas are also considered medically necessary for enteral feedings if they are indicated.

NOVITAS-JH-L34914, Assays for Vitamins and Metabolic Function

NOVITAS-JL-L34914, Assays for Vitamins and Metabolic Function

A56416, Billing and Coding: Assays for Vitamins and Metabolic Function

CIGNA-0136, Infant Nutritional Formula

AETNA-CPB-0061

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