Does H95.00 require prior authorization?

No, H95.00 does not require prior authorization (high confidence). Covered without prior authorization.

`H95.00`, Recurrent cholesteatoma of postmastoidectomy cavity, unspecified ear

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

See appendix for additional details on documentation requirements (policy references an appendix)
All medical necessity criteria must be clearly documented in the member's medical record and made available upon request.
Billing rule: For continuous intraoperative neurophysiology monitoring in the operating room with one-on-one monitoring requiring personal attendance, increments of less than 8 minutes should not be billed.
No documentation requirements are specified in this excerpt.

Intraoperative EMG monitoring of the facial nerve during surgery for cholesteatoma, including mastoidotomy or mastoidectomy
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "H93.3x1 - H93.3x9" Disorders of acoustic nerve [compression].
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I06.0 - I06.9" Diseases of aortic valve.
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I35.0 - I35.9" Nonrheumatic aortic valve disorders.
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I70.0" Atherosclerosis of aorta.
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I71.00 - I71.9" Dissection of aorta.

AETNA-CPB-0697, Intraoperative Neurophysiological Monitoring

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