Does G47.34 require prior authorization?

No, G47.34 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G47.34` — Idiopathic sleep related nonobstructive alveolar hypoventilation

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
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.
If a sleep study is performed for less than six hours, bill with modifier 52 and report the appropriately reduced original charge.
Medical records must document the signs, symptoms, or complaints demonstrating the indication for sleep testing; if the patient is admitted, documentation must explicitly support inpatient admission and indications.

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
Diagnostic polysomnography or other sleep testing is covered when the patient has symptoms or complaints of one of the conditions listed in LCD L36839.
A single polysomnogram (PSG) with EEG is ordinarily sufficient and covered to evaluate and diagnose suspected obstructive sleep apnea (OSA).
Diagnosis of narcolepsy is ordinarily confirmed by up to three Multiple Sleep Latency Test (MSLT) naps; MSLT (CPT 95805) performed appropriately is covered for this indication.
Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.
Home sleep testing performed with a WatchPAT device should be billed with CPT code 95800 or 95801.

L36839 — Polysomnography and Other Sleep Studies

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A56903 — Billing and Coding: Polysomnography and Other Sleep Studies

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L38528 — Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

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A57496 — Billing and Coding: Polysomnography and Sleep Testing

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