Does D21.21 require prior authorization?

No, D21.21 does not require prior authorization (high confidence). Covered without prior authorization.

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`D21.21`, Benign neoplasm of connective and other soft tissue of right lower limb, including hip

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM codes that reflect the patient's condition and the reason for the service; claims without ICD-10-CM codes will be returned.

Key Coverage Criteria

Nonvascular extremity ultrasound is covered when medical necessity is documented in the patient's record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Diagnostic nonvascular extremity ultrasound is covered when the claim includes an ICD-10-CM diagnosis code that best describes the patient's condition and the test result or the symptoms prompting the test are documented.
Coverage for lower extremity major joint replacement (hip and knee) is subject to the reasonable and necessary requirements of Local Coverage Determination L36007; services meeting LCD L36007 criteria are covered.
CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Simultaneous bilateral hip or knee replacement during the same encounter is covered when medical necessity for bilateral procedure is documented; bilateral procedures are subject to bilateral pricing.

20 Active Policies

CGS-J15-L40232, Total Joint Arthroplasty

J15

CGS-J18-L40232, Total Joint Arthroplasty

J18

A59811, Billing and Coding: Total Joint Arthroplasty

WPS-J5-L39911, Total Joint Arthroplasty

A57452, Billing and Coding: Peripheral Nerve Blocks

NGS-J6-L33619, Nonvascular Extremity Ultrasound

NGS-J6-L36850, Peripheral Nerve Blocks

A56787, Billing and Coding: Nonvascular Extremity Ultrasound

WPS-J8-L39911, Total Joint Arthroplasty

FIRST_COAST-L33618, Major Joint Replacement (Hip and Knee)

FIRST_COAST-L33933, Peripheral Nerve Blocks

A57765, Billing and Coding: Major Joint Replacement (Hip and Knee)

NOVITAS-JH-L36007, Lower Extremity Major Joint Replacement (Hip and Knee)

NGS-JK-L33619, Nonvascular Extremity Ultrasound

NGS-JK-L36850, Peripheral Nerve Blocks

NOVITAS-JL-L36007, Lower Extremity Major Joint Replacement (Hip and Knee)

A56796, Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)

A57788, Billing and Coding: Peripheral Nerve Blocks

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A60250, Billing and Coding: Total Joint Arthroplasty

`D21.21`, Benign neoplasm of connective and other soft tissue of right lower limb, including hip

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

D21.21, Benign neoplasm of connective and other soft tissue of right lower limb, including hip

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`D21.21`, Benign neoplasm of connective and other soft tissue of right lower limb, including hip