Does E75.4 require prior authorization?

No, E75.4 does not require prior authorization (high confidence). Covered without prior authorization.

`E75.4`, Neuronal ceroid lipofuscinosis

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.
Document evaluations and re-evaluations and bill re-evaluations using the evaluation CPT code (per policy guidance).
Document selection/prescription and programming/modification of speech-generating devices and use CPT 92607/92608 for selection/prescription and CPT 92609 for programming/modification on claims.
Claims and coding must follow the complementary Local Coverage Determination (LCD L34429) guidelines referenced in this policy.

Coverage for programming and modification of speech-generating devices using CPT 92609.
Coverage for individual outpatient treatment of speech, language, voice, communication, and/or auditory processing disorders using CPT 92507.
Coverage for group outpatient treatment (2 or more individuals) of speech, language, voice, communication, and/or auditory processing disorders using CPT 92508.
Coverage for selection and prescription of speech-generating devices (SGDs) using CPT 92607 and 92608.
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.

AMBETTER-CP.MP.99, Wheelchair Seating

UHC-POL-brineura-cerliponase-alfa, Brineura (Cerliponase Alfa)

AETNA-CPB-0158, Neuropsychological and Psychological Testing

AETNA-CPB-0353, Transcranial Doppler Ultrasonography

AETNA-CPB-0703, Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow

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