Does J98.01 require prior authorization?

No, J98.01 does not require prior authorization (high confidence). Covered without prior authorization.

`J98.01`, Acute bronchospasm

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.
This article provides billing, coding, and guideline information that complements Local Coverage Determination (LCD) L34410 for B-type Natriuretic Peptide (BNP) testing; refer to LCD L34410 for clinical coverage criteria.
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.

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.
BNP testing is covered when medical necessity is documented in the patient's record in accordance with the related Local Coverage Determination (LCD).
BNP testing performed as a diagnostic test should have the test result reported on the claim if known; if result is not known, report the symptoms that prompted the test.
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.

A56826, Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

NGS-J6-L33573, B-type Natriuretic Peptide (BNP) Testing

NOVITAS-JH-L35434, Oximetry Services

NGS-JK-L33573, B-type Natriuretic Peptide (BNP) Testing

A57205

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