Does E0746 require prior authorization?

No, E0746 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`E0746` — Electromyography (emg), biofeedback device

HCPCS/CPT

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation Required

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage of the service requested; refer to the protocol titled 'Medical Records Documentation Used for Reviews.'
When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan; in the event of a conflict, the member specific benefit plan document governs.
For TMJ surgical procedures: 'For medical necessity clinical coverage criteria, refer to the InterQual® CP: Procedures' (Arthroscopy, Discectomy, Reconstruction) and 'InterQual® Client Defined, CP: Procedures, Arthroplasty, Temporomandibular Joint (TMJ) (Custom) - UHG' — documentation to meet InterQual criteria is required

Key Coverage Criteria

Treatment of Temporomandibular Joint (TMJ) disorders
The following non-surgical services are proven and medically necessary for treating disorders of the temporomandibular joint (TMJ): Arthrocentesis
The following non-surgical services are proven and medically necessary for treating disorders of the temporomandibular joint (TMJ): Intra-articular injections of corticosteroids
The following non-surgical services are proven and medically necessary for treating disorders of the temporomandibular joint (TMJ): Trigger point injections
The following non-surgical services are proven and medically necessary for treating disorders of the temporomandibular joint (TMJ): Physical therapy
The following non-surgical services are proven and medically necessary for treating disorders of the temporomandibular joint (TMJ): Occlusal splint (stabilization and repositioning splints)

20 Active Policies

CIGNA-CPG294 — Biofeedback - (CPG294)

AETNA-CPB-0132 — Biofeedback

AETNA-CPB-0679 — Levator Syndrome Treatments

ANTHEM-MED.00130 — MED.00130 Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring

ANTHEM-CG-MED-97 — CG-MED-97 Biofeedback and Neurofeedback

Have a follow-up question?

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

When applying this policy to Medicare Advantage plans in the absence of a Medicare NCD or LCD, coverage determinations may rely on objective evidence-based rationale; documentation should support meeting such evidence-based criteria (Medicare IOM Pub. No. 100-16, Ch. 4, §90.5).

Applicable CPT and HCPCS codes are provided for reference; listing of a code in the policy does not imply that the service described by the code is a covered or non-covered health service — claims require supporting medical record documentation

When outcomes or objective measures are used in studies, documentation may include pre- and post-treatment objective testing/results (e.g., anal manometry, Vaizey score, Wexner Incontinence Scores, FI-QOL scores, number of complete spontaneous bowel movements, EMG measures, HRV measures, Berg Balance Scale, Timed Up and Go, treadmill gait kinematics, headache frequency/intensity diaries).

UHC-POL-temporomandibular-joint-disorders — Treatment of Temporomandibular Joint Disorders

UMR-POL-UMR-temporomandibular-joint-disorders — Treatment of Temporomandibular Joint Disorders

SUREST-POL-SUREST-temporomandibular-joint-disorders — Treatment of Temporomandibular Joint Disorders

BCBSIL-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence

BCBSMT-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence

BCBSNM-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence

BCBSOK-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence

BCBSIL-PSY301.018 — Biofeedback as a Treatment of Chronic Pain

BCBSMT-PSY301.018 — Biofeedback as a Treatment of Chronic Pain

BCBSNM-PSY301.018 — Biofeedback as a Treatment of Chronic Pain

BCBSOK-PSY301.018 — Biofeedback as a Treatment of Chronic Pain

BCBSIL-PSY301.019 — Biofeedback as a Treatment of Headache

BCBSMT-PSY301.019 — Biofeedback as a Treatment of Headache

BCBSNM-PSY301.019 — Biofeedback as a Treatment of Headache

BCBSOK-PSY301.019 — Biofeedback as a Treatment of Headache

E0746 — Electromyography (emg), biofeedback device