Does G47.36 require prior authorization?

No, G47.36 does not require prior authorization (high confidence). Covered without prior authorization.

`G47.36`, Sleep related hypoventilation in conditions classified elsewhere

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims for covered bariatric surgery must include three diagnosis codes with the primary diagnosis as E66.01, E66.812, or E66.813 and secondary/tertiary diagnoses from the specified ICD-10-CM code groups (group 1 and group 2).
When using CPT 43843 or CPT 43999 to bill a Not Otherwise Classified (NOC) or specific open procedures, include a note identifying the specific test/procedure performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Refer to LCD L35022 for complete reasonable-and-necessary documentation requirements and retain supporting medical records as required by Medicare policy.
If a sleep study is performed for less than six hours, bill with modifier 52 and report the appropriately reduced original charge.

Coverage for selected bariatric surgical procedures is allowed only for patients who meet the national and local reasonable-and-necessary criteria set forth in LCD L35022.
Claims for covered bariatric procedures must report three diagnoses: a primary diagnosis of morbid obesity (one of E66.01, E66.812, or E66.813), a secondary diagnosis from ICD-10-CM Code group 1, and a tertiary diagnosis from ICD-10-CM Code group 2.
Use CPT 43659 when both the gastric band and the subcutaneous port components were removed and replaced in the same encounter.
Diagnostic polysomnography or other sleep testing is covered when the patient has symptoms or complaints of one of the conditions listed in LCD L36839.
A single polysomnogram (PSG) with EEG is ordinarily sufficient and covered to evaluate and diagnose suspected obstructive sleep apnea (OSA).
Diagnosis of narcolepsy is ordinarily confirmed by up to three Multiple Sleep Latency Test (MSLT) naps; MSLT (CPT 95805) performed appropriately is covered for this indication.

CGS-J15-L36902, Polysomnography and Other Sleep Studies

J15

CGS-J18-L36902, Polysomnography and Other Sleep Studies

J18

A56903, Billing and Coding: Polysomnography and Other Sleep Studies

WPS-J5-L38528, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

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