Does J30.1 require prior authorization?

No, J30.1 does not require prior authorization (high confidence). Covered without prior authorization.

`J30.1`, Allergic rhinitis due to pollen

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and indicate the reason(s) the service was performed; claims without ICD-10-CM codes will be returned.
For diagnostic tests, report the test result on the claim if known; if the result is not known at time of claim, report the symptoms that prompted the test.
The name and NPI of the referring/ordering physician must be reported on the claim when required by the service.

RAST type tests are covered when medically necessary and supported by the related Local Coverage Determination (LCD) and current medical literature or standards of practice.
Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.
Standard skin testing is the preferred method when allergy testing is necessary.
When a percutaneous or intracutaneous single test (CPT 95004 or 95024) and sequential/incremental tests (CPT 95017, 95018, 95027) are performed the same day, both code types may be reported only if they are for different allergens or for different dilutions of the same allergen.
CPT code 95060 is payable in office, outpatient hospital (on-campus/off-campus), inpatient hospital, and emergency room settings.

CGS-J15-L34063, RAST Type Tests

J15

CGS-J15-L40056, Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J15

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J18-L40325, Allergy Diagnostic Testing

J18

CGS-J18-L40056

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