J84.9 — Interstitial pulmonary disease, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization 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.
- Select and report the appropriate CPT® code for the Envisia Genomic Classifier on the claim.
- Enter one unit of service (1 UOS) when reporting the Envisia Genomic Classifier service.
Key Coverage Criteria
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- Use these billing and coding instructions when reporting the Envisia™ Genomic Classifier (Veracyte) test for diagnosis/evaluation of suspected idiopathic pulmonary fibrosis as governed by LCD L37857.
- Envisia™ Genomic Classifier testing for evaluation of suspected idiopathic pulmonary fibrosis/interstitial lung disease when coverage and medical necessity criteria of LCD L37919 are met.
- Respiratory pathogen panel testing is covered when performed in an outpatient, non-institutional Part B setting from a single biologic specimen on a single date of service and the order is not a reflex test.
- Respiratory pathogen panel testing is covered when the medical record documents that the testing facility can deliver timely results and that the test results can reasonably be expected to change clinical management and improve patient health outcomes.
- Respiratory pathogen panel testing is covered when performed as a single service from a single biologic specimen in the outpatient setting on a single date of service and is reasonable and necessary per LCD L38918.
20 Active Policies
L37919 — MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
J05
A57568 — Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
J05
A57205 — Billing and Coding: Oximetry Services
J12
L35434 — Oximetry Services
J12
Related Codes
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