Does J93.9 require prior authorization?

No, J93.9 does not require prior authorization (high confidence). Covered without prior authorization.

`J93.9`, Pneumothorax, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
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.
Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
ICD-10 codes listed as covered diagnoses for the above procedures: J43.0 - J43.9 (Emphysema [except due to alpha-1-antitrypsin deficiency]) and J93.81 - J93.9 (Other pneumothorax and air leak [Recurrence of pneumothorax]).
CPT/HCPCS codes covered if selection criteria are met (examples listed in policy): 31647, 31648, 31649, 31651, 32141, 32491, 32655, 32672, G0302, G0303, G0304, G0305 (see policy for full code descriptions and coding details).
Lung volume reduction surgery (LVRS) for patients with advanced chronic obstructive pulmonary disease (COPD) due to emphysema (selected patients).
LVRS provides a survival advantage for patients with predominantly upper‑lobe emphysema and low baseline exercise capacity (as shown in the NETT trial).
Bilateral LVRS may produce greater spirometric improvement than unilateral procedures in appropriate candidates.

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

AETNA-CPB-0160, Lung Denervation Therapy and Lung Volume Reduction Surgery

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

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