Does J84.10 require prior authorization?

No, J84.10 does not require prior authorization (high confidence). Covered without prior authorization.

`J84.10`, Pulmonary fibrosis, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
Report CPT code 81554 for the Envisia™ Genomic Classifier service.
Enter 1 unit of service (UOS) for CPT code 81554.

Envisia™ Genomic Classifier testing for evaluation of suspected idiopathic pulmonary fibrosis/interstitial lung disease when coverage and medical necessity criteria of LCD L37919 are met.
Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT® or PLA code and an accompanying ICD-10-CM diagnosis that documents medical necessity in the patient record.
FDA-cleared/approved molecular infectious disease tests performed consistent with their intended use are covered without a DEX Z-code when billed with an appropriate supporting ICD-10-CM code.
A panel is a single test (single unit of service UOS=1) and is covered as one service even if it reports multiple pathogens or targets.
Testing for additional organisms not included in a billed panel is covered when ordered in addition to the panel and supported by documentation in the medical record.
Expanded (>5 pathogen) respiratory (RP/PNP) and gastrointestinal (GI) panels are covered when either (a) performed at POS 19, 21, 22, or 23, or (b) ordered by an approved specialist per patient immune status and clinical indication (see documentation criteria).

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

J15

CGS-J15-L37905, MolDX: Envisiaâ¢, Veracyteâ¢, Idiopathic Pulmonary Fibrosis Diagnostic Test

J15

CGS-J18-L37905, MolDX: Envisiaâ¢, Veracyteâ¢, Idiopathic Pulmonary Fibrosis Diagnostic Test

J18

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

J18

Ask Backwork about documentation requirements, denial risks, or coverage in your state.