Does R91.1 require prior authorization?

No, R91.1 does not require prior authorization (high confidence). Covered without prior authorization.

`R91.1`, Solitary pulmonary nodule

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.
This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
The document provides billing, coding, and other guidelines that complement LCD BDX-XL2 (L37031); claims should follow the LCD and any prior authorization or documentation requirements specified by that LCD.
A specific written order (referral/prescription) by the physician or appropriate NPP must be on file for all respiratory care services.

Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.
Pulmonary function tests (PFTs) represented by CPT codes 94070, 94200, 94640, 94726, 94727, and 94729 are covered when reasonable and medically necessary with supporting clinical documentation and a written order by a physician or appropriate NPP.
Spirometry (CPT 94010, 94011, 94012, 94060, 94070, 94150, 94200, 94375, 94726, 94727) is covered when clinically indicated and documented in the medical record.
Lung volume determination (CPT 94013, 94726, 94727, 94728) and diffusion capacity testing (CPT 94729) are covered when medically necessary and documented.
Pulmonary stress testing (CPT 94617, 94618, 94619, 94621) is covered when clinically indicated and supported by the medical record.
Device demonstration and/or evaluation (CPT 94664) is covered when used for device demonstration/evaluation purposes and documented as such in the medical record.

A59551, Billing and Coding: MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy

A57558, Billing and Coding: BDX-XL2

WPS-J5-L37216, BDX-XL2

WPS-J5-L39711, MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy

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