Does R61 require prior authorization?

No, R61 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R61`, Generalized hyperhidrosis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When submitting claims for Sudoscan/ESC testing using CPT 95999, the term SUDOSCAN or ESC (electrochemical skin conductance) must be entered in the narrative/remarks field (Item 19) on the CMS-1500 claim form or electronic equivalent.
Providers must document that autonomic testing is reasonable and necessary consistent with LCD L35395 and retain supporting medical records per LCD requirements.
Providers should consult and document coding/reporting consistent with the current year CPT manual for appropriate CPT assignments for autonomic function testing.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Medical records maintained by the performing provider must clearly support medical necessity and include test reports and the interpreting provider's interpretation.
Supporting documentation should include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures used to rule out more common causes of autonomic signs or symptoms.

Autonomic function tests are covered when they meet the reasonable and necessary requirements of Local Coverage Determination (LCD) L35395.
Cardiovagal innervation testing should be reported when performed using CPT code 95921.
Vasomotor adrenergic innervation testing should be reported when performed using CPT code 95922.
Sudomotor (sweat) function testing should be reported when performed using CPT code 95923, provided the testing meets the CPT-defined subject preparation, environmental, and personnel requirements.
Combined parasympathetic and sympathetic adrenergic function testing should be reported when performed using CPT code 95924.
Autonomic function testing is covered to confirm or exclude a specific autonomic nervous system disorder when medically necessary.

A57551, Billing and Coding: Autonomic Function Testing

WPS-J5-L35124, Autonomic Function Testing

A57024, Billing and Coding: Autonomic Function Testing

NGS-J6-L36236, Autonomic Function Testing

WPS-J8-L35124

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