R61, Generalized hyperhidrosis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
Key Coverage Criteria
- 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.
12 Active Policies
A57551, Billing and Coding: Autonomic Function Testing
J5
A57024, Billing and Coding: Autonomic Function Testing
J6
WPS-L35124, Autonomic Function Testing
J8
A57651, Billing and Coding: Autonomic Function Tests
J9
FIRST_COAST-L33609
Related Codes
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