Does R06.9 require prior authorization?

No, R06.9 does not require prior authorization (high confidence). Covered without prior authorization.

`R06.9`, Unspecified abnormalities of breathing

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
For diagnostic tests report the result of the test if known; otherwise report the symptoms that prompted performance of the test on the claim.
The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.
When applicable an Advance Beneficiary Notice (ABN) using Form CMS-R-131 should be signed; for Part A MAC claims include occurrence code 32 and the ABN date on the claim.

BNP testing is covered when performed as a diagnostic test for a valid, documented clinical indication and the claim includes a valid ICD-10-CM diagnosis code that best describes the patient's condition.
BNP testing to monitor the effectiveness of nesiritide therapy may be covered per local coverage policy L33943; follow that policy's specific coverage and frequency parameters.
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).

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

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

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L33943, B-type Natriuretic Peptide (BNP) Testing

J18

A56826

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