Does G40.833 require prior authorization?

No, G40.833 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G40.833` — Dravet syndrome, intractable, with status epilepticus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

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.
Ambulatory EEG is covered for diagnostic evaluation when seeking to detect clinical seizures or interictal epileptiform activity.
Ambulatory EEG is covered for pre-surgical evaluation to localize seizure onset when capture of multiple seizures is needed for surgical planning.

A57030 — Billing and Coding: EEG Ambulatory Monitoring

J06

L33399 — EEG Ambulatory Monitoring

J06

A57780 — Billing and Coding: Psychological and Neuropsychological Tests

J09

L34521 — Special EEG Tests

J09

L34520 — Psychological and Neuropsychological Tests

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