Does H91.11 require prior authorization?

No, H91.11 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H91.11` — Presbycusis, right ear

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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).

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.
CPT codes 92553, 92557, and 92568 are allowable when the beneficiary has current long-term use of ototoxic antibiotics.
The professional component (PC) of CPT codes 92537, 92538, 92541, 92542, 92544, 92545, 92546, 92587, 92588, 92651, 92652, and 92653 may be reported when the PC is performed in inpatient, outpatient, rehabilitation facilities, nursing facilities (when Part A benefits are exhausted), hearing and speech centers, independent clinics, or independent diagnostic testing facilities (IDTF).
Technical-only CPT codes 92547, 92552, 92553, 92555, 92556, 92562, 92563, 92565, 92571, 92572, 92575, 92576, 92577, 92582, 92583, and 92584 may be reported when performed in office settings, clinics, hearing and speech centers, and nursing facilities.
Payment for technical components of TC/PC services (when the PC is performed by an appropriate professional) and for technical-only services is allowed to hospitals.
Perform SEPs/SERs in the assessment of comatose patients when testing of somatosensory pathways is indicated.

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

J12

A57434 — Billing and Coding: Vestibular and Audiologic Function Studies

J12

L34975 — Neurophysiology Evoked Potentials (NEPs)

J12

L35007 — Vestibular and Audiologic Function Studies

J12

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