Does E71.529 require prior authorization?

No, E71.529 does not require prior authorization (high confidence). Covered without prior authorization.

`E71.529`, X-linked adrenoleukodystrophy, unspecified type

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For high-frequency chest compression systems: documentation of 'well-documented failure of standard treatments' to adequately mobilize retained secretions is required (i.e., evidence that standard treatments have been attempted and were inadequate).
For bronchiectasis indication: CT scan confirmation of bronchiectasis; clinical characterization of bronchiectasis (daily productive cough for at least 6 continuous months OR frequent exacerbations >2/year requiring antibiotic therapy).
For device coverage in neuromuscular disease: documentation of the specific neuromuscular diagnosis and evidence that the disease is causing significant impairment of chest wall and/or diaphragmatic movement; documentation that standard treatments (e.g., chest percussion and postural drainage) have not been successful in adequately mobilizing retained secretions.

Flutter / Acapella Device - ICD-10 codes covered if selection criteria are met : Q89.3 Quantitative Pupillometry/Pupillography
Home chest physiotherapy upon the initial prescription of chest physiotherapy to stabilize the member and to train family members or caregivers to administer chest physiotherapy.
Chest physiotherapy when the member’s pulmonary condition is unstable.
Airway oscillating devices (e.g., Flutter and Acapella) as medically necessary DME to assist in mobilizing respiratory tract secretions for members with: cystic fibrosis (CF), chronic bronchitis, bronchiectasis, immotile cilia syndrome (primary ciliary dyskinesia), and asthma.
Mechanical percussors (e.g., Fluid Flo, Frequencer, VibraLung Acoustical Percussor) as medically necessary DME for: cystic fibrosis, chronic bronchitis, bronchiectasis, immotile cilia syndrome, and asthma.
Positive expiratory pressure (PEP) mask as medically necessary DME for: cystic fibrosis, chronic bronchitis, immotile cilia syndrome, asthma, and chronic obstructive pulmonary disease (COPD).

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

AMBETTER-CP.MP.134, Evoked Potential Testing

AETNA-CPB-0067, Chest Physiotherapy and Airway Clearance Devices

AETNA-CPB-0202, Magnetic Resonance Spectroscopy (MRS)

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