Does E71.521 require prior authorization?

No, E71.521 does not require prior authorization (high confidence). Covered without prior authorization.

`E71.521`, Adolescent X-linked 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.
Chronic granulomatous disease
Allogeneic (ablative and non-myeloablative) hematopoietic stem cell transplantationis consideredmedically necessaryfor individuals with the following disorders. In addition, individuals with Sickle Cell Disease or Thalassemia should meet the Disease Specific Criteria below.
Bone Marrow Failure SyndromesAcquired aplastic anemia (drug, idiopathic, immune disorder, toxin or viral infection)Heritable bone marrow syndromes:Congenital amegakaryocytic thrombocytopenia (CAMT)Diamond-Blackfan anemia (DBA)Dyskeratosis congenitaFanconiâs anemia (FA)Schwachman-Diamond syndrome (SDS)Paroxysmal nocturnal hemoglobinuria (PNH)
Acquired aplastic anemia (drug, idiopathic, immune disorder, toxin or viral infection)
Heritable bone marrow syndromes:Congenital amegakaryocytic thrombocytopenia (CAMT)Diamond-Blackfan anemia (DBA)Dyskeratosis congenitaFanconiâs anemia (FA)Schwachman-Diamond syndrome (SDS)

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

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

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

ANTHEM-MP-A047560, TRANS.00029 Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias

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