Does G57.80 require prior authorization?

No, G57.80 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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`G57.80`, Other specified mononeuropathies 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.

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.
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.
NCS are indicated to diagnose or confirm suspected generalized neuropathies (for example diabetic, uremic, metabolic, or immune neuropathies).

5 Active Policies

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

A56607, Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

A56731, Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy

`G57.80`, Other specified mononeuropathies of unspecified lower limb

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

G57.80, Other specified mononeuropathies of unspecified lower limb

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`G57.80`, Other specified mononeuropathies of unspecified lower limb