H91.01 — Ototoxic hearing loss, right ear
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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).
- Use CPT code 95930 for Visual Evoked Potentials/Responses (VEPs/VERs).
Key Coverage Criteria
- 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.
- Outpatient psychiatry and psychology services are payable under Medicare Part B when provided in accepted places of service listed (e.g., office 11, outpatient hospital 22, telehealth in patient's home 10, etc.).
- Services of physicians, clinical psychologists, physician assistants, nurse practitioners, and clinical nurse specialists should be billed to the Part B Medicare Administrative Contractor (MAC).
- Individual psychotherapy CPT codes must be used when the primary focus of the treatment encounter is psychotherapy.
- When the visit is primarily psychotherapy and also includes pharmacological management, bill the appropriate psychotherapy code (which includes E/M) and CPT 90863 for pharmacological management in addition.
- For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
14 Active Policies
L34616 — Psychiatry and Psychology Services
J05
A57480 — Billing and Coding: Psychiatry and Psychology Services
J05
A56773 — Billing and Coding: Neurophysiology Evoked Potentials (NEPs)
J12
L34975 — Neurophysiology Evoked Potentials (NEPs)
J12
L35007
Related Codes
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