Does J84.9 require prior authorization?

No, J84.9 does not require prior authorization (high confidence). Covered without prior authorization.

`J84.9`, Interstitial pulmonary disease, 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.
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.
Respiratory pathogen panel testing is covered when performed as a single service from a single biologic specimen in the outpatient setting on a single date of service and is reasonable and necessary per LCD L38918.
The test is covered when performed in a Medicare Part B setting that is equipped to deliver timely results and when the results can reasonably be expected to lead to a change in clinical management that improves health outcomes.
Respiratory pathogen panel testing is covered when performed in an outpatient Medicare Part B setting using a single biologic specimen collected and tested on a single date of service, and the results are timely and can affect clinical management to improve patient health outcomes.

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

J15

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

J18

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

WPS-J5-L37919, MolDX: Envisiaâ¢, Veracyteâ¢, Idiopathic Pulmonary Fibrosis Diagnostic Test

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