Does E89.89 require prior authorization?

No, E89.89 does not require prior authorization (high confidence). Covered without prior authorization.

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`E89.89`, Other postprocedural endocrine and metabolic complications and disorders

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For neonatal or infant hearing screening: documentation of the use of limited ABR or limited OAE for screening; if screening fails, documentation that referral for comprehensive ABR/OAE occurred
General: medical records must support the specific covered indication, clinical findings, prior testing results (e.g., MRI/CT results when relevant), and that less invasive or standard diagnostic methods are inadequate or inconclusive when the policy requires prior evaluation
Medical necessity criteria must be clearly documented in the member's medical record and made available on request.

For cVEMP for suspected SCDS: documentation of a comprehensive evaluation including history, physical exam, audiometry, electronystagmography or videonystagmography, electrocochleography, and brainstem audiometry with inconclusive results prior to performing cVEMP

For SEPs to assess decline in unconscious spinal cord injury patients: documentation that the patient is unconscious, shows specific structural damage to the somatosensory system, and is a candidate for emergency spinal cord surgery

Key Coverage Criteria

To localize the cause of a visual field defect not explained by lesions seen on CT or MRI, metabolic disorders, or infectious diseases
Somatosensory evoked potentials (SEPs, SSEPs) or dermatosensory evoked potentials (DSEPs) are medically necessary for any of the following:
To assess any decline which may warrant emergent surgery in unconscious spinal cord injury persons who show specific structural damage to the somatosensory system, and who are candidates for emergency spinal cord surgery
To evaluate acute anoxic encephalopathy (within 3 days of the anoxic event)
To evaluate persons with suspected brain death
To identify clinically silent brain lesions in multiple sclerosis suspects to help establish the diagnosis when MS is suspected due to suggestive neurologic symptoms plus one or more other objective findings (brain plaques on MRI, clinical lesions by history and physical, and/or positive CSF determined by oligoclonal bands by established methods or increased IgG index)

`E89.89`, Other postprocedural endocrine and metabolic complications and disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

E89.89, Other postprocedural endocrine and metabolic complications and disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`E89.89`, Other postprocedural endocrine and metabolic complications and disorders