Does R06.02 require prior authorization?

No, R06.02 does not require prior authorization (high confidence). Covered without prior authorization.

`R06.02`, Shortness of breath

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims should include supporting clinical data: relevant medical history, physical examination findings, other laboratory studies, chest x-ray, and electrocardiography to demonstrate that BNP testing is being used in conjunction with standard diagnostics.
For risk stratification after ischemic events, documentation should indicate timing of BNP measurement relative to onset of ischemic symptoms (obtained in the first few days).
Either total BNP assays or N-terminal (NT-proBNP) assays are acceptable and the assay type should be documented on the claim or in the medical record.
All cardiovascular nuclear and stress tests must be referred by a physician or qualified non-physician provider; referrals must be documented in the medical record.

BNP testing is reasonable and necessary, when used with other medical data, to distinguish a cardiac cause of acute dyspnea from pulmonary or other non-cardiac causes.
BNP testing may be used to distinguish decompensated congestive heart failure from exacerbation of chronic obstructive pulmonary disease in a symptomatic patient with both chronic CHF and COPD.
BNP testing obtained in the first few days after onset of ischemic symptoms may be used for risk stratification (risk of death, myocardial infarction, or CHF) among patients with acute coronary syndrome, including myocardial infarction (with or without ST changes) and unstable angina.
Myocardial perfusion imaging is indicated to assess the functional and prognostic importance of angina.
Myocardial perfusion imaging is indicated for diagnostic evaluation of chest pain when the ECG is uninterpretable or equivocal due to drug effects, bundle branch block, or left ventricular hypertrophy.
Infarct-avid scintigraphy is indicated when myocardial infarction cannot be definitively diagnosed by electrocardiography or cardiac enzyme testing.

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L33943, B-type Natriuretic Peptide (BNP) Testing

J15

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J15-L40325, Allergy Diagnostic Testing

J15

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