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Prompt

Help me review this prior authorization for a Medicare patient needing a robotic-assisted lung biopsy. Validate credentials and codes, check coverage requirements, flag missing documentation, and draft a prior authorization recommendation.

Attachments

  • Fax - Medicare prior auth request4kbPDF
  • Patient history physical5kbDOC

Prior Authorization Review

Request Summary

Patient: X23F2

Procedure: Robotic-Assisted Peripheral Lung Biopsy (CPT 32405)

Provider: Dr. Sarah Chen, Pulmonology Associates

Submitted: December 18, 2025

Validation Checks

Provider NPI

Status: ✓ Verified

CPT Code (32405)

Status: ✓ Verified billable

ICD-10 (R91.1)

Status: ✓ Verified

Coverage Policy

Status: ✓ LCD L38319 applies

Medical Necessity (LCD L38319)

Pulmonary nodule on imaging

Documentation: 2.3cm spiculated nodule, RUL

Status: ✓ Met

Tissue diagnosis warranted

Documentation: PET SUV 4.2, concerning for malignancy

Status: ✓ Met

Surgical candidate

Documentation: FEV1 78% predicted

Status: ✓ Met

Less invasive approach tried

Documentation: Prior bronchoscopy non-diagnostic

Status: ✓ Met

Recommendation

✓ APPROVE

All LCD L38319 criteria met. Provider verified.

Audit Trail

NPI lookup

  • Source: NPI Registry MCP

ICD-10 validation

  • Source: ICD-10 Database MCP

Coverage search

  • Source: CMS Coverage Database MCP

Documentation review

  • Source: Uploaded files

Prior authorization

Prior authorization reviews take hours of cross-referencing while patients wait. Claude flags documentation gaps, catches who's been overlooked, and drafts requests ready for review.

Claude connects to your healthcare ecosystem

Coverage policies, coding systems, and clinical guidelines, all in one place.

AI you can trust

Claude is built on HIPAA-ready infrastructure with safety guardrails designed for healthcare. Answers can be traced back to the source, so you can verify before you act.

Powerful and contextual

Claude understands the complexity of medical coding, payer rules, and clinical decisions. It reviews your records and policies, then shows you where the answers came from. Work that took days now takes minutes.

Made for healthcare

Claude can connect to the data you need: CMS Coverage Database, ICD-10, NPI Registry, or PubMed. Sample skills give you a starting point to customize workflows with your organization's policies, data, and use cases.

Your partner in better care

We're investing in healthcare for the long term with a dedicated healthcare team, an expanding network of data partners like Function, HealthEx, Apple Health, Android Health Connect, and capabilities that grow with you.

Healthcare customers can access Claude via Claude for Enterprise and the Claude Platform.

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