J39.3 — Upper respiratory tract hypersensitivity reaction, site unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Policy references and complements Local Coverage Determination L33417 for Allergy Skin Testing; full LCD and policy text required to determine specific documentation and billing rules.
- 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.
Key Coverage Criteria
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- Allergy skin testing is covered when the patient presents with a clinically significant allergic history or symptoms not controllable by empiric conservative therapy.
- Testing is covered only when the test selection, technique, and interpretation specifically correlate with and are justified by a complete history and physical examination.
- Only test techniques and allergens with proven efficacy demonstrated in peer-reviewed medical literature are covered.
- Allergy testing is covered when the patient's environment provides a reasonable probability of exposure to the specific antigen tested.
- Medicare covers percutaneous (scratch/prick/puncture) testing for documented IgE-mediated reactions to inhalants.
6 Active Policies
A57205 — Billing and Coding: Oximetry Services
J12
L35434 — Oximetry Services
J12
A56559 — Billing and Coding: Allergy Skin Testing
A56717 — Billing and Coding: Respiratory Therapy (Respiratory Care)
L34430 — Respiratory Therapy (Respiratory Care)
Related Codes
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