Does J44.9 require prior authorization?

No, J44.9 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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`J44.9`, Chronic obstructive pulmonary disease, unspecified

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.
Coverage of transesophageal echocardiogram (TEE) is determined by the reasonable and necessary clinical criteria in Local Coverage Determination L33756; refer to LCD L33756 for specific covered indications.
Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.

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

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-L33756, Transesophageal Echocardiogram

A57179, Billing and Coding: Transesophageal Echocardiogram

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JL-L35434, Oximetry Services

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57205, Billing and Coding: Oximetry Services

A57361, Billing and Coding: Monitored Anesthesia Care

AMBETTER-CP.MP.181, Polymerase Chain Reaction Respiratory Viral Panel Testing

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

AETNA-CPB-0210, Phonophoresis

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

AETNA-CPB-0160, Lung Denervation Therapy and Lung Volume Reduction Surgery

`J44.9`, Chronic obstructive pulmonary disease, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J44.9, Chronic obstructive pulmonary disease, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J44.9`, Chronic obstructive pulmonary disease, unspecified