Does 95999 require prior authorization?

No, 95999 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 95999?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

When submitting claims for Sudoscan/ESC testing using CPT 95999, the term SUDOSCAN or ESC (electrochemical skin conductance) must be entered in the narrative/remarks field (Item 19) on the CMS-1500 claim form or electronic equivalent.
Providers must document that autonomic testing is reasonable and necessary consistent with LCD L35395 and retain supporting medical records per LCD requirements.
Providers should consult and document coding/reporting consistent with the current year CPT manual for appropriate CPT assignments for autonomic function testing.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Autonomic function tests are covered when they meet the reasonable and necessary requirements of Local Coverage Determination (LCD) L35395.
Cardiovagal innervation testing should be reported when performed using CPT code 95921.
Vasomotor adrenergic innervation testing should be reported when performed using CPT code 95922.
Sudomotor (sweat) function testing should be reported when performed using CPT code 95923, provided the testing meets the CPT-defined subject preparation, environmental, and personnel requirements.
Combined parasympathetic and sympathetic adrenergic function testing should be reported when performed using CPT code 95924.
Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

L36236 — Autonomic Function Testing

J06

A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography

J06

A57024

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