Does P36.10 require prior authorization?

No, P36.10 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P36.10` — Sepsis of newborn due to unspecified streptococci

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
A specific written order by the physician is required for all respiratory therapy services.
Medical records must fully document services rendered, clearly indicate that services were reasonable and medically necessary, and demonstrate that the skills of a licensed respiratory therapist were required for reimbursement.
For outpatient or extended care, Medicare coverage depends on the attending physician's determination, documented in the plan of treatment, that the procedures/exercises need to be performed by a respiratory therapist.

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
Respiratory therapy services prescribed by a physician or non-physician practitioner for assessment, diagnostic evaluation, treatment, management, or monitoring of deficiencies or abnormalities of cardiopulmonary function are covered.
Application techniques to support oxygenation and ventilation in acute illness (e.g., establishing/maintaining artificial airway, ventilatory therapy, precise oxygen delivery, and aiding removal of secretions) are covered when prescribed and documented as medically necessary.
Therapeutic use and monitoring of medicinal gases, pharmacologically active mists/aerosols, and related equipment (e.g., resuscitators, ventilators) are covered when medically necessary and prescribed.
Bronchial hygiene therapies (deep breathing, coughing exercises, IPPB, postural drainage, chest percussion/vibration, nasotracheal/endotracheal suctioning) are covered when individually prescribed and medically necessary.
Diagnostic tests for physician evaluation—pulmonary function tests (PFT), spirometry, and blood gas analyses—are covered when ordered and documented as medically necessary for respiratory assessment.

A56717 — Billing and Coding: Respiratory Therapy (Respiratory Care)

L34430 — Respiratory Therapy (Respiratory Care)

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