Does P28.40 require prior authorization?

No, P28.40 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P28.40`, Unspecified apnea of newborn

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.
Doppler interrogation must state the modes used and provide both qualitative and quantitative information.

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
ICD-10 codes covered if selection criteria are met (SNAP Testing system using 3 or more channels): F51.03 - F51.05; F51.13 - F51.19; F51.8; G47.00 - G47.39; G47.50 - G47.9; R06.00 - R06.09; R06.83 - R06.89; R06.81.
SNAP Testing using 3 or more channels is a medically necessary device for home diagnosis of OSA in adults, according to the criteria in CPB 0004 - Obstructive Sleep Apnea in Adults.
SNAP Testing system using 3 or more channels: HCPCS code G0400 (Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels) covered for adults only if selection criteria are met.

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

AETNA-CPB-0336, Acoustic Pharyngometers and SNAP Testing System

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

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