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ICD-10-CM P24.9, Neonatal aspiration, unspecified | No Prior Auth

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`P24.9`, Neonatal aspiration, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

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

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
Therapeutic use of iNO is consideredmedically necessarywhen either criterion AorB is met:
Inhaled nitric oxide is consideredmedically necessaryas a component of the treatment of hypoxic respiratory failure (see definition) in neonates when the following criteria are met:The neonate was born at 34 or more weeks of gestation;andConventional therapies have failed;andNeonate does not have a congenital diaphragmatic hernia;or
The neonate was born at 34 or more weeks of gestation;and
Conventional therapies have failed;and
Neonate does not have a congenital diaphragmatic hernia;or

2 Active Policies

ANTHEM-CG-MED-69, Inhaled Nitric Oxide

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

Related Codes

I27.83(2 policies)P24.81(2 policies)I27.20(2 policies)I27.29(2 policies)P24.01(2 policies)P24.11(2 policies)I27.0(2 policies)94004(1 policies)

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