Does R62.50 require prior authorization?

No, R62.50 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`R62.50` — Unspecified lack of expected normal physiological development in childhood

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

The plan of care should be ongoing (i.e., updated as the patient's condition changes), and treatment should demonstrate reasonable expectation of improvement.
"A reasonable estimate of when the goals will be reached;"
"Long-term and short-term goals that are specific, quantitative and objective;"
"Cognitive therapy evaluation;"

Key Coverage Criteria

ICD-10 G92.00 - G92.9 Toxic encephalopathy (covered if selection criteria are met).
Rehabilitation for visuo-spatial deficits (generally entails 20 1-hour sessions delivered over the course of 4 weeks).
Rehabilitation for language and communication deficits (persons usually receive 8 hours of weekly therapy, beginning at 4 weeks post-onset and continuing up to 48 weeks post-onset).
Cognitive rehabilitation is considered medically necessary for encephalopathy due to HIV when medical necessity criteria in section I above are met.
ICD-10 F07.81 Postconcussion syndrome (covered if selection criteria are met).
Cognitive rehabilitation as adjunctive treatment of cognitive deficits (e.g., attention, language, memory, reasoning, executive functions, problem solving, and visual processing) when performed by a licensed health care professional acting within their scope of practice and all of the following are met: Neuropsychological testing has been performed and neuropsychological results will be used in treatment-planning and directing rehabilitation strategies; and The cognitive deficits have been acqui [...]

7 Active Policies

AMBETTER-CG-Exome-Genome-Gntc-DO-2025.1 — Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders

AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1 — Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay

AETNA-CPB-0214 — Cognitive Rehabilitation

AETNA-CPB-0220 — Distraction Osteosynthesis

Have a follow-up question?

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

R62.50 — Unspecified lack of expected normal physiological development in childhood