Does Z87.01 require prior authorization?

No, Z87.01 does not require prior authorization (high confidence). Covered without prior authorization.

`Z87.01`, Personal history of pneumonia (recurrent)

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Treating physician must clearly document medical necessity to initiate IVIg therapy and the continued need for ongoing therapy in the medical record.
Include a History and Physical (H&P) in the medical record supporting IVIg therapy.
Include office and/or progress notes that document clinical status, response, and ongoing need for IVIg.
Provide relevant test results with written interpretation supporting the indication for IVIg.

IVIg (intravenous immune globulin) is covered when medically necessary as determined and documented by the treating physician, consistent with the associated Local Coverage Determination (LCD).
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.

AMBETTER-CP.MP.242, Pulmonary Function Testing

AETNA-CPB-0572, Home/Ambulatory Spirometry

A57187, Billing and Coding: Immune Globulin Intravenous (IVIg)

A57224, Billing and Coding: Respiratory Care

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