Does R04.9 require prior authorization?

No, R04.9 does not require prior authorization (high confidence). Covered without prior authorization.

`R04.9`, Hemorrhage from respiratory passages, unspecified

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.
Claims must meet the reasonable and necessary documentation requirements specified in LCD L35035; include clinical records demonstrating medical necessity per the LCD.
Follow the NCCI Coding Policy Manual (Chapters V and IX) for proper coding; retain documentation supporting compliance with NCCI edits.
When billing services that the LCD does not cover, use the appropriate Medicare modifier and document the basis for billing a non-covered service.

Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A57056, Billing and Coding: Aortography and Peripheral Angiography

FIRST_COAST-L36767, Aortography and peripheral angiography

NOVITAS-JH-L35434

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