Does J98.8 require prior authorization?

No, J98.8 does not require prior authorization (high confidence). Covered without prior authorization.

`J98.8`, Other specified respiratory disorders

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Billing and coding for pulmonary stress testing must follow Local Coverage Determination (LCD) L33444; consult LCD L33444 for specific medical necessity, coding, and billing criteria.
This article provides billing, coding, or other guidelines that complement LCD L33444 rather than standalone coverage criteria.
A specific written order (referral/prescription) by the physician or appropriate NPP must be on file for all respiratory care services.

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
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.
Lung volume determination (CPT 94013, 94726, 94727, 94728) and diffusion capacity testing (CPT 94729) are covered when medically necessary and documented.
Pulmonary stress testing (CPT 94617, 94618, 94619, 94621) is covered when clinically indicated and supported by the medical record.

AMBETTER-CP.MP.242, Pulmonary Function Testing

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

A56784, Billing and Coding: Pulmonary Stress Testing

A57224, Billing and Coding: Respiratory Care

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