Does G47.39 require prior authorization?

No, G47.39 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`G47.39`, Other sleep apnea

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Claims must be supported by documentation required by LCD L34576 (medical records demonstrating eligibility, medical necessity, and any prior authorization if applicable).
Follow payer-specific coding, modifiers, and claim form requirements for laparoscopic sleeve gastrectomy as outlined in this billing/coding guidance and the LCD.
If a sleep study is performed for less than six hours, bill with modifier 52 and report the appropriately reduced original charge.

Key Coverage Criteria

Billing and coding guidance applies to laparoscopic sleeve gastrectomy (sleeve gastrectomy) performed for severe obesity and is intended to complement LCD L34576.
Use this policy's billing/coding rules when submitting claims for laparoscopic sleeve gastrectomy; follow the clinical indication criteria in LCD L34576 for medical necessity determinations.
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.
Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.

20 Active Policies

A56903, Billing and Coding: Polysomnography and Other Sleep Studies

WPS-J5-L36839, Polysomnography and Other Sleep Studies

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

WPS-J8-L36839, Polysomnography and Other Sleep Studies

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G47.39, Other sleep apnea