Does E71.511 require prior authorization?

No, E71.511 does not require prior authorization (high confidence). Covered without prior authorization.

`E71.511`, Neonatal adrenoleukodystrophy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Refer to LCD L34975 for the detailed reasonable and necessary clinical criteria and documentation required to support coverage of NEPs.
Use CPT codes 95925, 95926, 95927, 95928, 95929, 95938, and 95939 for Somatosensory Evoked Potentials/Responses (SEPs/SERs).
Use CPT codes 92651, 92652, and 92653 for Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs).
Use CPT code 95930 for Visual Evoked Potentials/Responses (VEPs/VERs).

Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
Perform SEPs/SERs in evaluation of myoclonus to assess somatosensory pathway involvement.
Perform SEPs/SERs in the assessment of comatose patients when testing of somatosensory pathways is indicated.
Use VEPs/VERs to detect optic neuritis at an early or subclinical stage.
Perform SEPs/SERs for evaluation after spinal cord trauma when central somatosensory pathway injury is suspected.
Perform SEPs/SERs for degenerative, non‑traumatic spinal cord lesions (e.g., cervical spondylosis with myelopathy) when central somatosensory pathway involvement is suspected.

NOVITAS-JH-L34975, Neurophysiology Evoked Potentials (NEPs)

NOVITAS-JL-L34975, Neurophysiology Evoked Potentials (NEPs)

A56773, Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

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