Does J44.1 require prior authorization?

No, J44.1 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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`J44.1`, Chronic obstructive pulmonary disease with (acute) exacerbation

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

For CPT 97032, document the type of electrical stimulation (including 'manual'/'attended'), area(s) treated, and if used for muscle weakness provide objective strength ratings and functional deficits; if used for pain provide pain rating, pain location, and effect on function.
For HCPCS G0283, document the type of electrical stimulation (e.g., TENS, IFC), area(s) treated, and objective/subjective measures showing impact on pain intensity/location/functional impact and/or swelling.
For non-implantable pelvic floor stimulation, document cognitive intactness, patient motivation, and a failed documented trial of PME training (defined as no clinically significant improvement after 4 weeks of an ordered PME plan).

Key Coverage Criteria

Attended/manual electrical stimulation (CPT 97032) is covered when the qualified professional provides direct 1-on-1 patient contact to apply/manualy adjust stimulation (e.g., direct motor point stimulation, FES/NMES when combined with therapeutic exercise/neuromuscular reeducation/functional activities).
Non-implantable pelvic floor electrical stimulation delivered via vaginal or anal probes (reportable as CPT 97032) is covered for stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
Unattended/supervised electrical stimulation provided as part of a therapy plan of care (HCPCS G0283) is covered for non-wound indications (e.g., TENS, IFC, cyclical muscle stimulation) when used to control pain and/or swelling and when objective/subjective improvement is documented.
Electromagnetic therapy (HCPCS G0329) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.
Unattended electrical stimulation for wound management (HCPCS G0281) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not shown measurable healing after 30 days of conventional care.
Individual pulmonary rehabilitation components are covered when tailored to the individual patient based on a thorough evaluation, require a qualified clinician due to complexity, and are medically reasonable and necessary for treatment of an acute or exacerbated pulmonary condition.

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

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

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

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

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

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

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

FIRST_COAST-L38918, Respiratory Pathogen Panel Testing

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

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JH-L38916, Respiratory Pathogen Panel Testing

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

NGS-L39027, Respiratory Pathogen Panel Testing

NOVITAS-JL-L38916, Respiratory Pathogen Panel Testing

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

AMBETTER-CP.MP.242, Pulmonary Function Testing

A56152, Billing and Coding: Pulmonary Rehabilitation Services

A53065, Billing and Coding: Outpatient Physical Therapy

`J44.1`, Chronic obstructive pulmonary disease with (acute) exacerbation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J44.1, Chronic obstructive pulmonary disease with (acute) exacerbation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J44.1`, Chronic obstructive pulmonary disease with (acute) exacerbation