Does J20.5 require prior authorization?

No, J20.5 does not require prior authorization (high confidence). Code is covered without prior authorization.

`J20.5` — Acute bronchitis due to respiratory syncytial virus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
A specific written order (referral/prescription) by the physician or appropriate NPP must be on file for all respiratory care services.
Medical records must fully document that services were reasonable and medically necessary, with results and usage of the test documented in the record and available upon request.

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.

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

L40181 — Off-Label Use of Intravenous Immune Globulin (IVIG)

J06

A59105 — Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)

J06

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