Does J84.111 require prior authorization?

No, J84.111 does not require prior authorization (high confidence). Covered without prior authorization.

`J84.111`, Idiopathic interstitial pneumonia, not otherwise specified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
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.

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

J15

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

J18

WPS-J5-L37205, Chemotherapy Drugs and their Adjuncts

A57568, Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test

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