Does P28.5 require prior authorization?

No, P28.5 does not require prior authorization (high confidence). Covered without prior authorization.

`P28.5`, Respiratory failure of newborn

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For anticoagulation alternatives (e.g., argatroban), documentation of indication for alternative anticoagulation (e.g., HIT or AT deficiency) and target monitoring strategy (aPTT/ACT targets).
No documentation requirements are specified in this document chunk. The excerpt is a reference list and does not include required medical record, test result, or clinical documentation statements.
When ECMO is requested as a bridge (to transplant or to durable mechanical circulatory support): documentation of intent (bridge to heart, liver, lung or heart-lung transplantation or to durable mechanical circulatory support) and short-term intent (hours to a few days) as appropriate.
For neonates: documentation that the neonate meets all selection criteria — explicit recorded diagnosis from the policy list (e.g., congenital diaphragmatic hernia; hyaline membrane disease; meconium aspiration; persistent fetal circulation; possible cardiac anomaly; refractory neonatal septic shock; respiratory distress syndrome; uncontrollable air leak), documented gestational age (>= 34 weeks), documented birth weight (>= 2,000 grams), and documented age at time of ECMO (< 10 days, preferably < 7 days).

P29.30 - P29.38 Persistent fetal circulation
Neonates: ECMO in neonates who meet all of the following criteria: Diagnosis of any of the following: Congenital diaphragmatic hernia; or Hyaline membrane disease; or Meconium aspiration; or Persistent fetal circulation; or Possible cardiac anomaly; or Refractory neonatal septic shock; or Respiratory distress syndrome; or Uncontrollable air leak; and Gestational age of at least 34 weeks; and Birth weight of 2,000 grams or greater; and Age less than 10 days (preferably less than 7 days).
Children and adults: ECMO and extracorporeal life support (ECLS) for children and adults with any of the following diagnoses when the risk of death is very high despite optimal conventional therapy: Adult respiratory distress syndrome (ARDS); or As a short-term (i.e., hours to a few days) bridge to heart, liver, lung or heart-lung transplantation; or As a short-term bridge to durable mechanical circulatory support; or Following heart surgery to ease transition from cardiopulmonary bypass to vent [...]
33947 initiation, veno-arterial
I47.20, I47.21, I47.29 Ventricular tachycardia
I49.01 Ventricular fibrillation

ANTHEM-CG-MED-69, Inhaled Nitric Oxide

AETNA-CPB-0518, Nitric Oxide, Inhalational (INO)

AETNA-CPB-0546, Extracorporeal Membrane Oxygenation (ECMO)

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