Does E75.25 require prior authorization?

No, E75.25 does not require prior authorization (high confidence). Covered without prior authorization.

`E75.25`, Metachromatic leukodystrophy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
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).

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.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Assessment of idiopathic venous thrombo-embolism, recurrent venous thrombo-embolism, thrombosis occurring at a young age (i.e., less than 45 years of age), or thrombosis at an unusual site.
CPT code 83090 (Homocysteine) — covered if selection criteria are met.
ICD-10: D51.0 - D51.9 (Vitamin B12 deficiency anemia) — covered when selection criteria are met.

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

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

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

CIGNA-CPG129, Electrodiagnostic Testing (EMG/NCV)

AETNA-CPB-0158

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