B50.0 — Plasmodium falciparum malaria with cerebral complications
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim.
- The diagnosis code(s) submitted must accurately and specifically describe the patient's condition for which the visual electrophysiology test was performed.
- Follow applicable NCCI and OPPS billing requirements and edits prior to claim submission as coding may be affected by these edits.
- The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD.
Key Coverage Criteria
- Electroretinography (ERG) is covered when medically necessary and consistent with locally accepted standards of practice and is supported by an appropriate ICD-10-CM diagnosis that best describes the patient's condition.
- For diagnostic ERG tests, report the test result if known; if the result is not known at time of billing, report the symptoms that prompted the performance of the test.
- VEP/VER is covered to confirm the diagnosis of multiple sclerosis when clinical diagnostic criteria are inconclusive.
- VEP/VER is covered to evaluate diseases of the optic nerve including optic neuritis, ischemic optic neuropathy, toxic amblyopia, nutritional amblyopia, neoplasm compressing anterior visual pathways, optic nerve injury, or optic atrophy.
- VEP/VER is covered to evaluate suspected malingering or functional vision loss to help rule out nonorganic vision loss.
- VEP/VER is covered for intraoperative monitoring of the visual system during optic nerve or related surgery (monitoring of short-latency evoked potentials).
15 Active Policies
A57599 — Billing and Coding: Visual Electrophysiology Testing
J05
L37015 — Visual Electrophysiology Testing
J05
A57060 — Billing and Coding: Visual Electrophysiology Testing
J06
L36831 — Visual Electrophysiology Testing
J06
AETNA-CPB-0650
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.