87338
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Complete medical history and physical examination (medical evaluation).
- Documentation of standardized olfactory testing administered prior to work-up: e.g., University of Pennsylvania Smell Identification Test (UPSIT) or the University of Connecticut Test Battery to establish impairment of the sense of smell.
- Records of nasal mucous membrane examination; indication for biopsy when intra-nasal or intra-oral neoplasm is suspected and biopsy pathology report when performed.
- Documentation supporting drug assays and chemical analyses when certain medications or nutritional deficiencies (e.g., zinc deficiency) are suspected causes.
Key Coverage Criteria
- Nasal endoscopy.
- ICD-10 diagnoses covered if selection criteria are met: R43.0 - R43.9 (Disturbances of smell and taste).
- Evaluations of members with unexplained olfactory dysfunction (e.g., anosmia, hyposmia, dysosmia) and gustatory dysfunction (e.g., ageusia, hypogeusia, dysgeusia).
- Biopsy of the olfactory mucosa (medically necessary for the evaluations of members with unexplained olfactory dysfunction).
- Drug assays and chemical analyses when certain medications or nutritional deficiencies are the suspected causes of the disorders.
- Electroencephalography (EEG) for members with a history of seizures.
1 Active Policy
AETNA-CPB-0390 — Smell and Taste Disorders: Diagnosis
Related Codes
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