Does E75.25 require prior authorization?

No, E75.25 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E75.25` — Metachromatic leukodystrophy

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Refer to LCD L34975 for the detailed reasonable and necessary clinical criteria and documentation required to support coverage of NEPs.
Use CPT codes 95925, 95926, 95927, 95928, 95929, 95938, and 95939 for Somatosensory Evoked Potentials/Responses (SEPs/SERs).
Use CPT codes 92651, 92652, and 92653 for Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs).

Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
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.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis

A56773 — Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

J12

L34975 — Neurophysiology Evoked Potentials (NEPs)

J12

A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck

AETNA-CPB-0158 — Neuropsychological and Psychological Testing

AETNA-CPB-0202 — Magnetic Resonance Spectroscopy (MRS)

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