Does J95.863 require prior authorization?

No, J95.863 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`J95.863`, Postprocedural seroma of a respiratory system organ or structure following other procedure

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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

This billing and coding guideline complements Local Coverage Determination (LCD) L34424 for Magnetic Resonance Angiography; refer to LCD L34424 for clinical indications, medical necessity criteria, and specific coding rules.

Key Coverage Criteria

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.
Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.
Pulmonary function tests (PFTs) represented by CPT codes 94070, 94200, 94640, 94726, 94727, and 94729 are covered when reasonable and medically necessary with supporting clinical documentation and a written order by a physician or appropriate NPP.
Spirometry (CPT 94010, 94011, 94012, 94060, 94070, 94150, 94200, 94375, 94726, 94727) is covered when clinically indicated and documented in the medical record.

5 Active Policies

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

A56717, Billing and Coding: Respiratory Therapy (Respiratory Care)

A56730, Billing and Coding: Respiratory Therapy and Oximetry Services

A56775, Billing and Coding: Magnetic Resonance Angiography

A57224, Billing and Coding: Respiratory Care

`J95.863`, Postprocedural seroma of a respiratory system organ or structure following other procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

J95.863, Postprocedural seroma of a respiratory system organ or structure following other procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`J95.863`, Postprocedural seroma of a respiratory system organ or structure following other procedure