Does P27.0 require prior authorization?

No, P27.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P27.0`, Wilson-Mikity syndrome

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.
A treatment plan to attain goals with justification for continuing the rehabilitation program, including frequency and duration.
Evidence of communication with the referring physician.
Periodic objective exercise testing demonstrating measurable findings of physical and functional status showing improvement from baseline (usually at least every 5 visits).

Patients with COPD who are symptomatic with FEV1 < 50% predicted (recommended by ACP/ACCP/ATS/ERS as indicated for PR).
Patients with COPD who are symptomatic or exercise-limited with FEV1 > 50% predicted (may be considered).
Entry into a medically supervised outpatient pulmonary rehabilitation program is medically necessary when ALL of the following criteria are met (general criteria):
Member has chronic pulmonary disease (including alpha-1 antitrypsin deficiency, asbestosis, asthma, emphysema, chronic airflow obstruction, chronic bronchitis, cystic fibrosis, fibrosing alveolitis, pneumoconiosis, pulmonary alveolar proteinosis, pulmonary fibrosis, pulmonary hemosiderosis, persistent pulmonary impairment from COVID-19, radiation pneumonitis),
Member has other conditions that affect pulmonary function such as ankylosing spondylitis, bronchopulmonary dysplasia, Guillain-Barre' syndrome or other infective polyneuritis, lung cancer, muscular dystrophy, myasthenia gravis, paralysis of diaphragm, sarcoidosis, or scoliosis
Member has dyspnea at rest or with exertion

AETNA-CPB-0032, Pulmonary Rehabilitation

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

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