Does G57.70 require prior authorization?

No, G57.70 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`G57.70`, Causalgia of unspecified lower limb

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
Claims and coding must follow the Local Coverage Determination L37642 that this article complements; medical record documentation should support the billed service in accordance with LCD L37642.
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.

Key Coverage Criteria

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.
Spinal cord stimulation (SCS) is covered for chronic pain when the clinical record documents the diagnosis and prior conservative therapies tried before the decision to use SCS.
Temporary SCS trials (CPT 63650) are covered when performed in an office, ambulatory surgical center (ASC), outpatient hospital, or hospital with appropriate clinical documentation.

10 Active Policies

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

FIRST_COAST-L33933, Peripheral Nerve Blocks

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

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G57.70, Causalgia of unspecified lower limb