Does J45.901 require prior authorization?

No, J45.901 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`J45.901`, Unspecified asthma 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

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.

Key Coverage Criteria

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.

20 Active Policies

CGS-J15-L34063, RAST Type Tests

J15

CGS-J15-L40325, Allergy Diagnostic Testing

J15

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

J15

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

J15

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

J18

CGS-J18-L40325, Allergy Diagnostic Testing

J18

CGS-J18-L40056, Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J18

CGS-J18-L34063, RAST Type Tests

J18

WPS-J5-L40195, Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

A60276, Billing and Coding: Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

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

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

WPS-J5-L36408, Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

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

NGS-J6-L40329, Allergy Diagnostic Testing

NGS-J6-L40048, Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

NGS-J6-L33591, RAST Type Tests

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

A56844, Billing and Coding: RAST Type Tests

`J45.901`, Unspecified asthma with (acute) exacerbation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J45.901, Unspecified asthma with (acute) exacerbation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J45.901`, Unspecified asthma with (acute) exacerbation