K0742
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Chronic obstructive pulmonary disease;or
- Cystic fibrosis;or
- Diffuse interstitial lung disease;or
- Pulmonary hypertension;or
- Pulmonary neoplasm (primary or metastatic);or
- Dependent edema secondary to right heart failure;or
1 Active Policy
ANTHEM-CG-DME-18 — CG-DME-18 Home Oxygen Therapy
Related Codes
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