Does N52.35 require prior authorization?

No, N52.35 does not require prior authorization (high confidence). Covered without prior authorization.

`N52.35`, Erectile dysfunction following radiation therapy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must document medical necessity and meet the reasonable and necessary requirements specified in Novitas LCD L35050.
WatchPAT studies must be billed using CPT 95800 or 95801; actigraphy/CPAP documentation should be billed with CPT 95803 when used for NCD CPAP documentation or when accepted by the DME contractor.
Providers must check NCCI edits and follow NCCI correct coding guidelines before billing; this policy does not override NCCI.
All facility-based sleep studies must be under the direction of a physician licensed in the state and board certified or board eligible in sleep medicine (AASM/ABMS) and attended by trained technologists; non-hospital facilities must also be accredited by AASM, The Joint Commission, or ACHC.

Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.
Home sleep testing performed with a WatchPAT device should be billed with CPT code 95800 or 95801.
Actigraphy may be reported with CPT code 95803 to document CPAP coverage under the applicable NCD or as follow-up CPAP administration when accepted by the DME contractor.
Narcolepsy: facility-based overnight polysomnography followed by a facility-based MSLT is covered to confirm narcolepsy, including assessment of nighttime sleep, first REM latency, MSLT, and presence of REM-sleep episodes.
Repeat polysomnography is covered when the initial study is technically inadequate (equipment failure), the patient could not sleep or slept insufficiently, results were inconclusive/ambiguous, or when initiation/confirmation of therapy is needed.
Obstructive sleep apnea (OSA) diagnostic testing is covered when AHI/RDI ≥ 15 events/hour, or AHI 5–14 events/hour with documented symptoms (excessive daytime sleepiness, impaired cognition, mood disorder, or insomnia) or documented hypertension, ischemic heart disease, or history of stroke.

NOVITAS-JH-L35050, Outpatient Sleep Studies

NOVITAS-JL-L35050, Outpatient Sleep Studies

A56923, Billing and Coding: Outpatient Sleep Studies

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