Does E71.528 require prior authorization?

No, E71.528 does not require prior authorization (high confidence). Covered without prior authorization.

`E71.528`, Other 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.
Somatosensory evoked potentials testing.
Intraoperative neurophysiologic evoked potentials monitoring to help prevent neurologic injury during neurological, orthopedic, and other types of surgeries.
Evaluate prognosis of acute anoxic encephalopathy within the initial 72 hours of onset (e.g., after cardiac arrest).
Assess decline in status in unconscious spinal cord injury patients with structural somatosensory system damage who are candidates for emergency spinal cord surgery.
Aid in the diagnosis of multiple sclerosis.

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

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

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

AMBETTER-CP.MP.134, Evoked Potential Testing

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