Does P07.30 require prior authorization?

No, P07.30 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P07.30` — Preterm newborn, unspecified weeks of gestation

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Quantitative EEG must be performed only as an adjunct to a traditional EEG (policy phrase: "medically necessary only as an adjunct to traditional EEG")
Use must match one of the medically necessary purposes listed (ambulatory recording to facilitate subsequent expert visual EEG interpretation; continuous EEG monitoring by frequency-trending in OR/ICU; evaluation when neuroimaging and routine EEG are inconclusive for cerebrovascular disease; evaluation of dementia/encephalopathy when diagnosis unresolved after initial clinical evaluation; screening for possible epileptic seizures in high-risk ICU members; screening for spikes/seizures during long-term EEG monitoring; topographic voltage and dipole analysis in pre-surgical evaluations for intractable epilepsy)
Claims for CPT codes 95961 and +95962 and HCPCS S8040 require that the applicable selection criteria be met (policy repeatedly notes "covered if selection criteria are met")

ICD-10 codes covered if selection criteria are met (not all-inclusive): F02.80: Dementia in other diseases classified elsewhere, without behavioral disturbance
ICD-10 codes covered if selection criteria are met (not all-inclusive): F02.A0, F02.B0, F02.C0, F02.C4: Dementia in other diseases classified elsewhere, with behavioral disturbance
ICD-10 codes covered if selection criteria are met (not all-inclusive): F03.90 - F03.C4: Unspecified dementia
ICD-10 codes covered if selection criteria are met (not all-inclusive): F06.1, F06.8: Psychotic disorders with hallucinations and other specified mental disorders due to known physiological conditions
ICD-10 codes covered if selection criteria are met (not all-inclusive): G40.00 - G40.919: Epilepsy and recurrent seizures
ICD-10 codes covered if selection criteria are met (not all-inclusive): G92.00 - G92.9: Toxic encephalopathy

AETNA-CPB-0221 — Quantitative EEG (Brain Mapping)

AETNA-CPB-0318 — Palivizumab (Synagis)

AETNA-CPB-0579 — T-Wave Alternans

ANTHEM-CG-MED-69 — CG-MED-69 Inhaled Nitric Oxide

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