Does J62.8 require prior authorization?

No, J62.8 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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`J62.8`, Pneumoconiosis due to other dust containing silica

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.
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.
Use G9 anesthesia modifier to indicate need for MAC due to a history of severe or advanced cardiopulmonary disease when the proceduralist determines additional monitoring is required.

20 Active Policies

A59915, Billing and Coding: Pharmacogenomic Testing

NGS-J6-L39995, Pharmacogenomic Testing

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

A58812, Billing and Coding: Pharmacogenomics Testing

FIRST_COAST-L39073, Pharmacogenomics Testing

FIRST_COAST-L38918, Respiratory Pathogen Panel Testing

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JH-L39063, Pharmacogenomics Testing

NOVITAS-JH-L38916, Respiratory Pathogen Panel Testing

NOVITAS-JH-L35049, Monitored Anesthesia Care

NGS-L39027, Respiratory Pathogen Panel Testing

NGS-JK-L39995, Pharmacogenomic Testing

NOVITAS-JL-L35434, Oximetry Services

NOVITAS-JL-L38916, Respiratory Pathogen Panel Testing

NOVITAS-JL-L39063, Pharmacogenomics Testing

A57205, Billing and Coding: Oximetry Services

A57361, Billing and Coding: Monitored Anesthesia Care

A58801, Billing and Coding: Pharmacogenomics Testing

NOVITAS-JL-L35049, Monitored Anesthesia Care

A56784, Billing and Coding: Pulmonary Stress Testing

`J62.8`, Pneumoconiosis due to other dust containing silica

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J62.8, Pneumoconiosis due to other dust containing silica

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J62.8`, Pneumoconiosis due to other dust containing silica