Does G47.21 require prior authorization?

No, G47.21 does not require prior authorization (high confidence). Covered without prior authorization.

`G47.21`, Circadian rhythm sleep disorder, delayed sleep phase type

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
Claims must document medical necessity and meet the reasonable and necessary requirements specified in Novitas LCD L35050.
WatchPAT studies must be billed using CPT 95800 or 95801; actigraphy/CPAP documentation should be billed with CPT 95803 when used for NCD CPAP documentation or when accepted by the DME contractor.

CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.
Home sleep testing performed with a WatchPAT device should be billed with CPT code 95800 or 95801.
Actigraphy may be reported with CPT code 95803 to document CPAP coverage under the applicable NCD or as follow-up CPAP administration when accepted by the DME contractor.
Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JH-L35050, Outpatient Sleep Studies

A56923, Billing and Coding: Outpatient Sleep Studies

A57130, Billing and Coding: Psychiatric Codes

NOVITAS-JL-L35050

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