Does H91.09 require prior authorization?

No, H91.09 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H91.09`, Ototoxic hearing loss, unspecified ear

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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).
Use CPT code 95930 for Visual Evoked Potentials/Responses (VEPs/VERs).

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.
Outpatient psychiatry and psychology services are payable under Medicare Part B when provided in accepted places of service listed (e.g., office 11, outpatient hospital 22, telehealth in patient's home 10, etc.).
Services of physicians, clinical psychologists, physician assistants, nurse practitioners, and clinical nurse specialists should be billed to the Part B Medicare Administrative Contractor (MAC).
Individual psychotherapy CPT codes must be used when the primary focus of the treatment encounter is psychotherapy.
When the visit is primarily psychotherapy and also includes pharmacological management, bill the appropriate psychotherapy code (which includes E/M) and CPT 90863 for pharmacological management in addition.
For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J18-L34353, Outpatient Psychiatry and Psychology Services

J18

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

NOVITAS-JH-L35007, Vestibular and Audiologic Function Studies

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