Does B39.1 require prior authorization?

No, B39.1 does not require prior authorization (high confidence). Covered without prior authorization.

`B39.1`, Chronic pulmonary histoplasmosis capsulati

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.

A57484, Billing and Coding: Vitamin D Assay Testing

WPS-J5-L34658, Vitamin D Assay Testing

A57736, Billing and Coding: Vitamin D Assay Testing

NGS-J6-L37535, Vitamin D Assay Testing

WPS-J8-L34658, Vitamin D Assay Testing

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