Does J98.4 require prior authorization?

No, J98.4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`J98.4`, Other disorders of lung

ICD-10-CM

No Prior Auth Required

Code is 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.
Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.

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.
Noninvasive ear or pulse oximetry (CPT 94760, 94761) is covered when ordered by a physician or non-physician practitioner and determined medically necessary per LCD L33923.
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.

A56767, Billing and Coding: Heavy Metal Testing

NGS-J6-L35074, Heavy Metal Testing

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

NOVITAS-JH-L35434, Oximetry Services

NGS-JK-L35074

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