Does E10.52 require prior authorization?

No, E10.52 does not require prior authorization (high confidence). Covered without prior authorization.

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`E10.52`, Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must be submitted in accordance with CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 32 Section 150 (Billing Requirements for Bariatric Surgery for Morbid Obesity), including use of the procedure and diagnosis codes listed there and in this local article.
Coverage for Type II diabetes mellitus complication diagnosis codes is based on the Internet Only Manual (IOM); include documentation and citations required by IOM when billing these diagnoses.
Bariatric surgery claims must reference the applicable national coverage determination (CMS Pub 100-03 Chapter 1 Part 2 Section 100.1) when submitting for payment.

Key Coverage Criteria

Bariatric surgery for treatment of co-morbid conditions related to morbid obesity is payable when billed in accordance with CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter 1 Part 2 Section 100.1.
Additional diagnoses listed in this local coverage article for Part A procedure codes and the article's listed CPT codes are covered for bariatric surgery to treat co-morbid conditions related to morbid obesity.
Traditional negative pressure wound therapy (NPWT) devices, units, and supplies are covered under the Durable Medical Equipment (DME) benefit when they meet DME LCD coverage criteria and medical necessity.
CPT codes 97597, 97598, and wound debridement codes 11042-11047 may be covered when the medical record documents medical necessity consistent with L37228 Wound Care criteria and Medicare reasonable-and-necessary requirements.
Foot care services are covered when the beneficiary has a listed systemic condition that justifies coverage per Medicare Benefit Policy Manual Pub.100-02, Ch.15, Section 290.4D.
For diagnosis codes designated by an asterisk, the patient must be under the active care of an M.D. or D.O., documented as having been seen for the complicating disease within the 6 months prior to service.

20 Active Policies

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L38662, Implantable Continuous Glucose Monitors (I-CGM)

J15

CGS-J15-L34032, Debridement Services

J15

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

J15

CGS-J18-L38662, Implantable Continuous Glucose Monitors (I-CGM)

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

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

J18

CGS-J18-L34032, Debridement Services

J18

A54923, Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity

WPS-J5-L35761, Non-Invasive Peripheral Arterial Vascular Studies

WPS-J5-L37228, Wound Care

A55909, Billing and Coding: Wound Care

WPS-J5-L38686, Implantable Continuous Glucose Monitors (I-CGM)

WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A56232, Billing and Coding: Foot Care

WPS-J5-L35490, Category III Codes

A57593, Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

A58213, Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

`E10.52`, Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E10.52, Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E10.52`, Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene