Does S27.399A require prior authorization?

No, S27.399A does not require prior authorization (high confidence). Covered without prior authorization.

`S27.399A`, Other injuries of lung, unspecified, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
Medical records must document the signs, symptoms, diagnosis, or clinical rationale that meet one of the covered indications (e.g., acute respiratory symptoms, chronic respiratory/cardiopulmonary/neuromuscular disease and the specific reason for oximetry).

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
Oximetry is medically necessary for patients exhibiting acute respiratory dysfunction signs or symptoms (tachypnea, dyspnea, cyanosis, respiratory distress, confusion, or hypoxia).
Oximetry is medically necessary for patients with chronic lung disease, severe cardiopulmonary disease, or neuromuscular disease affecting respiratory muscles when used for initial evaluation to determine the severity of respiratory impairment.
Oximetry is medically necessary for patients with chronic lung disease, severe cardiopulmonary disease, or neuromuscular respiratory muscle disease to evaluate an acute change in condition.
Oximetry is medically necessary to evaluate exercise tolerance in a patient with respiratory disease.
Oximetry is medically necessary to establish the medical necessity of an oxygen therapeutic regimen in patients with chronic respiratory, cardiopulmonary, or neuromuscular disease affecting respiration.

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

A56717, Billing and Coding: Respiratory Therapy (Respiratory Care)

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