P28.0 — Primary atelectasis of newborn
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Thyroid function testing is consideredmedically necessaryfor individuals who meet any of the following indications:
- For evaluation of signs or symptoms consistent with thyroid disease;or
- To evaluate, assess, or monitor confirmed or suspected thyroid disease;or
- To evaluate thyroid function when there are risk factors for thyroid disease.
- Therapeutic use of iNO is consideredmedically necessarywhen either criterion AorB is met:
- Inhaled nitric oxide is consideredmedically necessaryas a component of the treatment of hypoxic respiratory failure (see definition) in neonates when the following criteria are met:The neonate was born at 34 or more weeks of gestation;andConventional therapies have failed;andNeonate does not have a congenital diaphragmatic hernia;or
2 Active Policies
ANTHEM-CG-LAB-20 — CG-LAB-20 Thyroid Testing
ANTHEM-CG-MED-69 — CG-MED-69 Inhaled Nitric Oxide
Related Codes
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