Does G57.90 require prior authorization?

No, G57.90 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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`G57.90`, Unspecified mononeuropathy 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.
Patient medical record must include the ordering provider's assessment related to the patient's complaint for that visit and relevant medical history.

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).
Peripheral nerve injection/nerve block for peripheral neuropathy may be covered when the medical record documents that the service is medically necessary for the patient's specific condition.
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.
Molecular genetic testing for identification and management of hereditary transthyretin (TTR) amyloidosis is covered per the referenced Local Coverage Determination L39935.

17 Active Policies

CGS-J15-L39940, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

J15

CGS-J18-L39940, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

J18

WPS-J5-L39987, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

A59906, Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J8-L39987, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

FIRST_COAST-L33933, Peripheral Nerve Blocks

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

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

A57663, Billing and Coding: Nerve Blocks for Peripheral Neuropathy

A57788, Billing and Coding: Peripheral Nerve Blocks

A59849, Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

A59862, Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

A59872, Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

ANTHEM-CG-LAB-13, Skin Nerve Fiber Density Testing

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

`G57.90`, Unspecified mononeuropathy of unspecified lower limb

Prior Authorization

Documentation Required

Key Coverage Criteria

17 Active Policies

Related Codes

Have a follow-up question?

G57.90, Unspecified mononeuropathy of unspecified lower limb

Prior Authorization

Documentation Required

Key Coverage Criteria

17 Active Policies

Related Codes

Have a follow-up question?

`G57.90`, Unspecified mononeuropathy of unspecified lower limb