Does A52.16 require prior authorization?

No, A52.16 does not require prior authorization (high confidence). Covered without prior authorization.

`A52.16`, Charcot's arthropathy (tabetic)

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Specified HCPCS codes require a face-to-face encounter and Written Order Prior to Delivery (WOPD) per Final Rule 1713; failure to obtain WOPD prior to delivery results in denial.
Supplier must include diagnosis code(s) on the claim line for HCPCS L4396, L4397, L4392 and L4631.
For custom-fabricated orthoses, the supplier's records must document medical necessity for a custom device rather than a prefabricated orthosis and be available upon request.
Supplier records must show the product specified by the treating practitioner, the treating practitioner's medical record that justifies the type of product (prefabricated versus custom), and detailed justification for the HCPCS code billed.

Ankle-foot orthoses (AFO) and knee-ankle-foot orthoses (KAFO) are covered when they are rigid or semi-rigid devices used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body.
Coverage requires that reasonable and necessary (R&N) medical necessity criteria in the related Local Coverage Determination (LCD) are met for the beneficiary's diagnosis or functional deficit.
An orthosis provided within two days prior to discharge to home is eligible for DME MAC coverage if it is medically necessary after discharge and was not needed for inpatient treatment or rehabilitation.
Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.
Electrical stimulation (attended CPT 97032 or unattended HCPCS G0283) may be covered as part of a therapy plan of care to improve function when the nerve supply to the muscle is intact and atrophy is due to non-neurological disuse (e.g., post-casting, splinting, soft-tissue scarring).

CGS-J15-L34056, Urodynamics

J15

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

CGS-J18-L34246, Routine Foot Care and Debridement of Nails

J18

CGS-J18-L34056, Urodynamics

J18

A56232, Billing and Coding: Foot Care

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