Does D16.30 require prior authorization?

No, D16.30 does not require prior authorization (high confidence). Covered without prior authorization.

`D16.30`, Benign neoplasm of short bones of unspecified lower limb

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
Medical record 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 selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Documentation should state whether the block was performed for diagnostic or therapeutic purposes.

Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Peripheral nerve block is reasonable when the patient's pain appears due to a classic mononeuritis but neuro-diagnostic studies fail to provide a structural explanation.
Peripheral nerve blocks are reasonable for peripheral nerve injuries/entrapment or extremity trauma that lead to complex regional pain syndrome (CRPS).
Selective peripheral nerve blockade is reasonable diagnostically when the clinical picture is unclear to isolate the specific pain source.
Occipital nerve block is reasonable to confirm suspected occipital neuralgia (used diagnostically and therapeutically).
Suprascapular nerve block is reasonable to confirm suspected suprascapular nerve entrapment producing shoulder pain and weakness.

FIRST_COAST-L33933, Peripheral Nerve Blocks

A57788, Billing and Coding: Peripheral Nerve Blocks

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