Does L8500 require prior authorization?

Yes, L8500 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`L8500`, Artificial larynx, any type

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation of recommendation for device use by a laryngologist or a speech-language pathologist for voice rehabilitation following total laryngectomy.
Documentation of total laryngectomy / clinical indication for voice restoration (diagnosis codes such as C32.x, D02.0, D14.1, Z85.21 where applicable).
Clinical documentation that member has adequate pulmonary function to force air from the trachea through the prosthesis into the esophagus (assessment of pulmonary reserve).
Clinical documentation that member has the manual dexterity to care for and clean the voice prosthesis daily.

Voice rehabilitation following total laryngectomy: indwelling tracheo-esophageal (TE) voice prosthesis is medically necessary when recommended by a laryngologist or a speech-language pathologist (see Appendix selection criteria).
Replacement of indwelling TE voice prosthesis is medically necessary (replacement every 3 to 6 months is consistent with the documented life span of most prostheses).
Hand-held artificial larynx devices (examples listed: Nu-Vois, OptiVox, Servox, SolaTone, TruTone, UltraVoice) are medically necessary for voice rehabilitation after total laryngectomy.
Non-indwelling voice prostheses (e.g., Provox NiD) are medically necessary when recommended by a laryngologist or a speech-language pathologist for voice rehabilitation following total laryngectomy.
Covered CPT code (if selection criteria met): 31611 - Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis.
Other related CPT codes noted: 31360-31365 (total laryngectomy).

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

AETNA-CPB-0560, Voice Prosthesis for Voice Rehabilitation Following Total Laryngectomy

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