E75.09 — Other GM2 gangliosidosis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- Document evaluations and re-evaluations and bill re-evaluations using the evaluation CPT code (per policy guidance).
- Document selection/prescription and programming/modification of speech-generating devices and use CPT 92607/92608 for selection/prescription and CPT 92609 for programming/modification on claims.
- Claims and coding must follow the complementary Local Coverage Determination (LCD L34429) guidelines referenced in this policy.
Key Coverage Criteria
- Coverage for programming and modification of speech-generating devices using CPT 92609.
- Coverage for individual outpatient treatment of speech, language, voice, communication, and/or auditory processing disorders using CPT 92507.
- Coverage for group outpatient treatment (2 or more individuals) of speech, language, voice, communication, and/or auditory processing disorders using CPT 92508.
- Coverage for selection and prescription of speech-generating devices (SGDs) using CPT 92607 and 92608.
- CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
- Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
10 Active Policies
AMBETTER-CP.MP.99 — Wheelchair Seating
A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck
AETNA-CPB-0158 — Neuropsychological and Psychological Testing
A56612 — Billing and Coding: CT of the Head
A56868 — Billing and Coding: Outpatient Speech Language Pathology
Related Codes
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