Does J44.0 require prior authorization?

No, J44.0 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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`J44.0`, Chronic obstructive pulmonary disease with (acute) lower respiratory infection

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

When a referring/ordering physician is required, the referring/ordering physician’s name and NPI must be reported on the claim.
Diagnosis code(s) must best describe the patient’s condition for which the service was performed and a valid ICD-10-CM code is required on the claim.
For an evaluation-only episode, the evaluation serves as the plan of care if it contains a diagnosis or a description from which a referring physician/NPP may determine a diagnosis, and the referral/order certifies the evaluation is needed.

Key Coverage Criteria

Skilled therapy services are covered when the skills of a qualified therapist are necessary to improve the patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration.
Rehabilitative therapy is covered when therapist skills are necessary to safely and effectively furnish a recognized therapy service with the goal of improving an impairment or functional limitation.
Maintenance therapy is covered only when an individualized clinical assessment documents that specialized judgment, knowledge, and skills of a qualified therapist are necessary to perform the maintenance program safely and effectively.
Physical therapy (CPT 97161-97163) and occupational therapy (CPT 97165-97167) evaluations are covered; when an evaluation is the only service in an episode, the evaluation serves as the plan of care if it contains a diagnosis or a description sufficient for the referring physician/NPP to determine a diagnosis.
BNP testing is covered when medical necessity is documented in the patient's record in accordance with the related Local Coverage Determination (LCD).
BNP testing performed as a diagnostic test should have the test result reported on the claim if known; if result is not known, report the symptoms that prompted the test.

20 Active Policies

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

A58761, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

NGS-J6-L33573, B-type Natriuretic Peptide (BNP) Testing

A56826, Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

A56566, Billing and Coding: Outpatient Physical and Occupational Therapy Services

WPS-J8-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

FIRST_COAST-L33923, Noninvasive Ear or Pulse Oximetry For Oxygen Saturation

FIRST_COAST-L38918, Respiratory Pathogen Panel Testing

NOVITAS-JH-L38916, Respiratory Pathogen Panel Testing

NOVITAS-JH-L35434, Oximetry Services

NGS-L39027, Respiratory Pathogen Panel Testing

NGS-JK-L33573, B-type Natriuretic Peptide (BNP) Testing

NOVITAS-JL-L35434, Oximetry Services

NOVITAS-JL-L38916, Respiratory Pathogen Panel Testing

A57205, Billing and Coding: Oximetry Services

AETNA-CPB-0115, Varicella and Herpes Zoster Vaccines

ANTHEM-CG-DME-54, Mechanical Insufflation-Exsufflation Devices

AETNA-CPB-0067, Chest Physiotherapy and Airway Clearance Devices

`J44.0`, Chronic obstructive pulmonary disease with (acute) lower respiratory infection

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J44.0, Chronic obstructive pulmonary disease with (acute) lower respiratory infection

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J44.0`, Chronic obstructive pulmonary disease with (acute) lower respiratory infection