Does E0619 require prior authorization?

No, E0619 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E0619` — Apnea monitor, with recording feature

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Physician must perform monthly review and document medical necessity for continued monitoring.
Documentation must show the device used is FDA-approved.
When available, documentation should indicate use of an event recorder.
Observer's report documenting the event and which sign(s) were present (cyanosis/pallor, breathing change, tone change, altered responsiveness)

Home cardiorespiratory (that is, apnea) monitoring is consideredmedically necessaryin any of the following infants:
Those who have experienced a brief resolved unexplained event (BRUE). If monitored due to BRUE, use of an apnea monitor is consideredmedically necessaryuntil event free for 2 to 3 months.
Those with tracheostomies or anatomic abnormalities of the face, tongue, jaw or airway that make them vulnerable to airway compromise.*
Those with neurologic or metabolic disorders affecting respiratory control.*
Those with chronic lung disease (such as, bronchopulmonary dysplasia), particularly those requiring supplemental oxygen; continuous positive airway pressure; or mechanical ventilation.*
Those with apnea of prematurity, defined as sudden cessation of breathing that lasts for at least 20 seconds or is accompanied by bradycardia (heart rate less than 80 beats per minute) or oxygen (O2) desaturation (O2saturation less than 90% or cyanosis) in an infant with early home discharge prior to term (38 weeks). Continued use is considered medically necessary up to 43 weeks postmenstrual age or event free for 2 weeks, whichever comes later.

ANTHEM-CG-DME-08 — CG-DME-08 Infant Home Apnea Monitors

BCBSIL-DME101.020 — Home Cardiorespiratory Monitoring

BCBSMT-DME101.020 — Home Cardiorespiratory Monitoring

BCBSNM-DME101.020 — Home Cardiorespiratory Monitoring

BCBSOK-DME101.020 — Home Cardiorespiratory Monitoring

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