Does P27.1 require prior authorization?

No, P27.1 does not require prior authorization (high confidence). Covered without prior authorization.

`P27.1`, Bronchopulmonary dysplasia originating in the perinatal period

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.
No explicit documentation requirements (e.g., pathology, prior treatments, diagnostic testing, or specific clinical notes) are listed in this background text.
No explicit documentation requirements are stated in this excerpt of the CPB.
The CPB provides lists of ICD-10 and HCPCS/CPT codes that are not covered for the indications listed; claim adjudication and medical record review should reference those coding lists to determine noncoverage.

No covered indications are explicitly listed in this CPB. The bulletin primarily designates adoptive immunotherapy and cellular therapy approaches described below as experimental and investigational (i.e., not supported as effective).
Note / exception: "This policy does not apply to lifileucel for the treatment of advanced melanoma." (lifileucel is handled separately).
For CAR T therapies and specific agent coverage consult the related CPBs referenced (e.g., CPB 0920 Kymriah, CPB 0924 Yescarta, CPB 0980 Tecartus, CPB 0986 Breyanzi, CPB 0992 Abecma, CPB 1007 Carvykti).
Metastatic melanoma (use of TIL, T-cell-based ACT, IL-2/LAK combinations discussed)
Renal cell carcinoma (IL-2 with or without LAK/TIL studied)
Lung cancer (including primary lung cancer; adjuvant chemo-immunotherapy using dendritic cells and activated killer cells; NSCLC)

AETNA-CPB-0318, Palivizumab (Synagis)

AETNA-CPB-0618, Brain Natriuretic Peptide Testing

AETNA-CPB-0641, Adoptive Immunotherapy and Cellular Therapy

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

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