Does B90.9 require prior authorization?

No, B90.9 does not require prior authorization (high confidence). Covered without prior authorization.

`B90.9`, Sequelae of respiratory and unspecified tuberculosis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
Medical record documentation of signs or symptoms that may be explained by bronchospasm.
Documentation of abnormal pre-bronchodilator spirometry when used as the basis for post-bronchodilator testing.
Documentation that reversibility of bronchospasm has not yet been demonstrated (or prior bronchodilator test results).

Pulmonary function testing (PFT) is medically necessary for members/enrollees aged ≥3 years when policy criteria are met.
Spirometry is medically necessary to evaluate symptoms, signs of impaired lung function, or abnormal laboratory tests, including unexplained dyspnea, wheezing, orthopnea, cough, or phlegm production.
Unexplained abnormal respiratory signs (decreased breath sounds, over-inflation, cyanosis, chest deformity, wheezing or unexplained adventitial sounds).
Abnormal laboratory or imaging findings suggesting respiratory impairment (hypoxemia, hypercapnia, polycythemia, or abnormal chest radiographs).
Indirect assessment of the effect of systemic disease on pulmonary function (e.g., neuromuscular disease, connective tissue disease).
Preoperative risk assessment for patients with known or suspected airway dysfunction.

AMBETTER-CP.MP.242, Pulmonary Function Testing

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

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