Does J96.20 require prior authorization?

No, J96.20 does not require prior authorization (high confidence). Covered without prior authorization.

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`J96.20`, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

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.
When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.

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.

Key Coverage Criteria

Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
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.

20 Active Policies

NGS-J6-L33627, Non-Invasive Vascular Studies

A56758, Billing and Coding: Non-Invasive Vascular Studies

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

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

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JH-L35434, Oximetry Services

NGS-JK-L33627, Non-Invasive Vascular Studies

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57361, Billing and Coding: Monitored Anesthesia Care

AMBETTER-CP.MP.242, Pulmonary Function Testing

ANTHEM-CG-MED-79, Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

AETNA-CPB-0546, Extracorporeal Membrane Oxygenation (ECMO)

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

A56625, Billing and Coding: Echocardiography

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

A56775, Billing and Coding: Magnetic Resonance Angiography

`J96.20`, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J96.20, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J96.20`, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia