Does E71.548 require prior authorization?

No, E71.548 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E71.548`, Other peroxisomal disorders

ICD-10-CM

No Prior Auth Required

Code is 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.
Nerve conduction velocity (NCV) testing AND needle electromyography testing (NEMG) are medically necessary when conducted and interpreted at the same time for any of the following indications:
Myopathy, including but not limited to: inflammatory myopathy and myositis (e.g., polymyositis, dermatomyositis, inclusion body myositis)
Congenital and hereditary dystrophic and nondystrophic myopathies, including myotonic muscular dystrophy
Acquired myopathies (drug induced myopathy associated with statins, thyroid related)
Metabolic myopathies (such as McArdle disease)

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

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

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

CIGNA-0136, Infant Nutritional Formula

CIGNA-CPG129, Electrodiagnostic Testing (EMG/NCV)

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