Does G57.50 require prior authorization?

No, G57.50 does not require prior authorization (high confidence). Covered without prior authorization.

`G57.50`, Tarsal tunnel syndrome, unspecified lower limb

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
Medical records must clearly document medical necessity for each test and include the reason for referral and a clear diagnostic impression.
Data gathered during NCS should be available showing actual numeric results (latency, amplitude, etc.), preferably in tabular format.
In cases of review, provide a hard copy of waveforms or a complete written report with interpretation upon request.

No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
NC-stat testing (CPT 95905) is allowed when the beneficiary has a high pre-test or prior probability of Carpal Tunnel Syndrome (CTS), limited to one service per arm.
Use CPT 95870 for sampling muscles other than the paraspinals associated with the extremities that have been tested.
Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Nerve conduction studies (NCS) are indicated for localization of focal neuropathies or compressive lesions such as carpal tunnel syndrome, ulnar neuropathies, and nerve root lesions.
NCS are indicated for diagnosis and prognosis of traumatic peripheral nerve lesions.

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L33933, Peripheral Nerve Blocks

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

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