G04.01, Postinfectious acute disseminated encephalitis and encephalomyelitis (postinfectious ADEM)ICD-10-CM
No Prior Auth Required
Covered without prior authorization (high confidence)
CGS-J15-L34394, Visual Fields Testing
J15
CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J15
CGS-J18-L34394, Visual Fields Testing
J18
CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J18
A58761, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J5
WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J5
A56551, Billing and Coding: Visual Fields Testing
J6
NGS-J6-L33574, Visual Fields Testing
J6
WPS-J8-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J8
NGS-JK-L33574, Visual Fields Testing
JK
A56771, Billing and Coding: Special Electroencephalography
A56799, Billing and Coding: Visual Fields Testing
A57204, Billing and Coding: MRI and CT Scans of the Head and Neck
A58710, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
A58720, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
A58747, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
AMBETTER-CP.VP.63, Visual Field Testing
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