Does G23.1 require prior authorization?

No, G23.1 does not require prior authorization (high confidence). Covered without prior authorization.

`G23.1`, Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski]

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When submitting claims for Sudoscan/ESC testing using CPT 95999, the term SUDOSCAN or ESC (electrochemical skin conductance) must be entered in the narrative/remarks field (Item 19) on the CMS-1500 claim form or electronic equivalent.
Providers must document that autonomic testing is reasonable and necessary consistent with LCD L35395 and retain supporting medical records per LCD requirements.
Providers should consult and document coding/reporting consistent with the current year CPT manual for appropriate CPT assignments for autonomic function testing.
Refer to LCD L34975 for the detailed reasonable and necessary clinical criteria and documentation required to support coverage of NEPs.

Autonomic function tests are covered when they meet the reasonable and necessary requirements of Local Coverage Determination (LCD) L35395.
Cardiovagal innervation testing should be reported when performed using CPT code 95921.
Vasomotor adrenergic innervation testing should be reported when performed using CPT code 95922.
Sudomotor (sweat) function testing should be reported when performed using CPT code 95923, provided the testing meets the CPT-defined subject preparation, environmental, and personnel requirements.
Combined parasympathetic and sympathetic adrenergic function testing should be reported when performed using CPT code 95924.
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.

A57551, Billing and Coding: Autonomic Function Testing

WPS-J5-L35124, Autonomic Function Testing

A57024, Billing and Coding: Autonomic Function Testing

NGS-J6-L36236, Autonomic Function Testing

WPS-J8-L35124

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