Does J96.00 require prior authorization?

No, J96.00 does not require prior authorization (high confidence). Covered without prior authorization.

`J96.00`, Acute respiratory failure, unspecified whether with hypoxia or hypercapnia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must contain relevant medical history, physical examination, and results of pertinent diagnostic tests that fully support the medical necessity of each non-invasive vascular study.
Diagnostic tests must be ordered by the treating practitioner (or consulting physician) who will use the test results in managing the patient's specific medical problem; the ordering practitioner's name and NPI must be reported on the claim when required.
Providers of interpretations and technical personnel must maintain documentation of training, licensure, certification, and proficiency for post-payment audit; IDTF supervising physicians must document proficiency in each diagnostic procedure performed.

Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.
Immediate post-operative studies of an access or bypass site are covered if pulses are lost, become equivocal, or the patient develops signs or symptoms of ischemia suggesting need for repeat intervention.
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-J6-L33627, Non-Invasive Vascular Studies

A56758, Billing and Coding: Non-Invasive Vascular Studies

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

FIRST_COAST-L33923, Noninvasive Ear or Pulse Oximetry For Oxygen Saturation

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JH-L35049, Monitored Anesthesia Care

NGS-JK-L33627, Non-Invasive Vascular Studies

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

A57361, Billing and Coding: Monitored Anesthesia Care

NOVITAS-JL-L35049, Monitored Anesthesia Care

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

A56775, Billing and Coding: Magnetic Resonance Angiography

A57115, Billing and Coding: Noninvasive Ear or Pulse Oximetry For Oxygen Saturation

AETNA-CPB-0339, Pulse Oximetry and Capnography for Home Use

ANTHEM-CG-LAB-20, Thyroid Testing

AMBETTER-CP.MP.242, Pulmonary Function Testing

AETNA-CPB-0067, Chest Physiotherapy and Airway Clearance Devices

AETNA-CPB-0298, Non-invasive Negative Pressure Ventilation: Body Ventilators and Poncho Wrap