Does N85.A require prior authorization?

No, N85.A does not require prior authorization (high confidence). Covered without prior authorization.

`N85.A`, Isthmocele

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

If used for an indication listed under the policy's 'experimental and investigational' section, there must be clear documentation supporting an evidentiary rationale — otherwise such use is considered investigational per policy (note: the policy states these uses are considered experimental/investigational and effectiveness has not been established).
Documented clinical presentation of painful sensory neuropathy.
Documented absence of a history of a disorder known to predispose to painful neuropathy (examples provided: diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy).
Physical examination documentation demonstrating no findings consistent with large-fiber neuropathy (e.g., no reduced or absent muscle-stretch reflexes; no reduced proprioception and vibration sensation).

Measurement of intra-epidermal nerve fiber density (IENFD) by skin biopsy is medically necessary for the diagnosis of small-fiber neuropathy when ALL of the following criteria are met: Individual presents with painful sensory neuropathy; and There is no history of a disorder known to predispose to painful neuropathy (e.g., diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); and Physical examination shows no evidence of findings consistent with large-f [...]
ICD-10 code listed as covered if selection criteria are met: G60.8 — Other hereditary and idiopathic neuropathies
Endometriosis
None explicitly listed as covered in this CPB. The policy identifies the following procedures as experimental and investigational (i.e., effectiveness not established and thus not supported by this policy): dorsal root ganglion stimulation; hypogastric plexus neurolysis for the treatment of chronic pelvic pain associated with endometriosis; peritoneal excision (stripping) for the treatment of endometriosis; uterine nerve ablation (UNA), laparoscopic uterine nerve ablation (LUNA) and presacral n [...]
Other indications related to pelvic pain addressed by selected treatments (policy scope: selected treatments for chronic pelvic pain, endometriosis, and other indications)

AETNA-CPB-0754, Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected Treatments

AETNA-CPB-0774, Nerve Fiber Density Measurement

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