Does J84.170 require prior authorization?

No, J84.170 does not require prior authorization (high confidence). Covered without prior authorization.

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`J84.170`, Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.

Key Coverage Criteria

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.
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.
Respiratory pathogen panel testing is covered when performed in an outpatient, non-institutional Part B setting from a single biologic specimen on a single date of service and the order is not a reflex test.
Respiratory pathogen panel testing is covered when the medical record documents that the testing facility can deliver timely results and that the test results can reasonably be expected to change clinical management and improve patient health outcomes.

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-L37205, Chemotherapy Drugs and their Adjuncts

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

A55639, Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions

WPS-J8-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

WPS-J8-L37205, Chemotherapy Drugs and their Adjuncts

FIRST_COAST-L38918, Respiratory Pathogen Panel Testing

NOVITAS-JH-L38916, Respiratory Pathogen Panel Testing

NOVITAS-JH-L35434, Oximetry Services

NGS-L39027, Respiratory Pathogen Panel Testing

NOVITAS-JL-L35434, Oximetry Services

NOVITAS-JL-L38916, Respiratory Pathogen Panel Testing

A57205, Billing and Coding: Oximetry Services

A58575, Billing and Coding: Respiratory Pathogen Panel Testing

A58577, Billing and Coding: Respiratory Pathogen Panel Testing

A58710, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58720, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A56730, Billing and Coding: Respiratory Therapy and Oximetry Services

`J84.170`, Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J84.170, Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J84.170`, Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere