Does R06.01 require prior authorization?

No, R06.01 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R06.01` — Orthopnea

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record, be legible, include complete patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
Every submitted medical record page must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
If the service provider differs from the ordering/referring physician, the performing provider must maintain hard copy documentation of test results and interpretation plus copies of the ordering/referring physician’s order for the studies.

Coverage for non-emergent outpatient stress testing is subject to the reasonable and necessary requirements in Local Coverage Determination L35083 and is allowed only when L35083 clinical criteria are met.
Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
BNP testing is covered when medical necessity is documented in the patient's record in accordance with the related Local Coverage Determination (LCD).

A57476 — Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J05

L34636 — Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J05

L33577 — Transthoracic Echocardiography (TTE)

J06

A56826 — Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

J06

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