Does J02.0 require prior authorization?

No, J02.0 does not require prior authorization (high confidence). Covered without prior authorization.

`J02.0`, Streptococcal pharyngitis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When performing pH-impedance testing for EoE evaluation or esophageal atresia, concurrent upper GI endoscopy and histology were used in studies ('All patients underwent upper GI endoscopy and pH-impedance monitoring' in the cited study).
For MII-pH testing in refractory GERD, documentation of PPI dosing and timing when test is performed (on vs off PPI) — UpToDate guidance: administer high-dose acid-suppressive therapy for at least 1 week before combined MII-pH testing when evaluating refractory GERD; perform testing off PPIs when unclear if GERD is cause of symptoms ('we administer high-dose acid-suppressive therapy ... for at least 1 week before combined MII-pH testing' and 'we perform MII-pH testing off PPIs' when indicated).
Probe synchronization and correct placement (studies noted measures to electronically synchronize probes when using two technologies concurrently).

ICD-10 codes listed as covered for MII-EM (when selection criteria are met): R07.9 (chest pain), R11.10–R11.14 (vomiting), R12 (heartburn), R13.10–R13.14 (dysphagia).
CPT codes covered when selection criteria are met for esophageal pH monitoring: 91034 (nasal catheter pH), 91035 (mucosal attached telemetry pH / Bravo alternative) — (subject to the modality-specific selection criteria noted above).
ICD-10 codes listed as covered for esophageal pH monitoring (when selection criteria are met): J02.0–J02.9 (acute pharyngitis), J04.0 (acute laryngitis), J31.2 (chronic pharyngitis), J37.0 (chronic laryngitis), J45.20–J45.50 (intermittent and persistent asthma, uncomplicated), K21.00–K21.9 (GERD), R05.1–R05.9 (cough), R07.9 (chest pain, unspecified).
CPT codes covered when selection criteria are met for MII / MII-pH: 91037 (nasal catheter intraluminal impedance placement, recording, analysis, interpretation), 91038 (prolonged MII, >1 hour up to 24 hours).
ICD-10 codes listed as covered for MII (when selection criteria are met): K21.00–K21.9 (GERD), R05.1–R05.9 (cough), R06.2 (wheezing), R10.0–R10.13 / R10.30–R10.9 (abdominal pain), R11.11 (vomiting without nausea), R12 (heartburn), R14.0–R14.3 (flatulence), R43.8 (disturbances of smell/taste), R62.50 (poor growth), R63.3 (feeding difficulties).
CPT codes covered when selection criteria are met for MII-EM: 91010 (esophageal motility/manometry), 91037, 91038 (prolonged).

ANTHEM-CG-SURG-113, Tonsillectomy with or without Adenoidectomy for Adults

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

AETNA-CPB-0646, Voice Therapy

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

AETNA-CPB-0667, Esophageal and Airway pH Monitoring

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