Does G61.9 require prior authorization?

No, G61.9 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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`G61.9`, Inflammatory polyneuropathy, unspecified

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

When routine foot care needs to meet one of the exclusions, include the applicable Q modifier on the claim: Q7 for 1 Class A finding, Q8 for 2 Class B findings, and Q9 for 1 Class B plus 2 Class C findings.
For all foot-care claims report an appropriate foot/toe location modifier (e.g., LT, RT, TA, T1-T9) to identify laterality and specific toe when applicable.
If a significant, separately identifiable evaluation and management service is provided on the same day as routine foot care, append modifier -25 to the E/M claim line.
Total the number of keratotic lesions debrided and select the most appropriate CPT code 11055-11057 based on that total (example: code 11056 for two to four lesions).

Key Coverage Criteria

Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Somatosensory evoked potential (SEP) testing should be billed using CPT codes 95925, 95926, 95927, or 95938 when an SEP study (not QST) is performed.
Intraoperative somatosensory monitoring during spinal surgeries may be billed with CPT 95940 or HCPCS G0453 in conjunction with the SEP study (95925, 95926, 95927, or 95938) when continuous one-on-one monitoring is provided.

14 Active Policies

A57589, Billing and Coding: Nerve Blocks for Peripheral Neuropathy

FIRST_COAST-L33958, Somatosensory Testing

NOVITAS-JH-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

NOVITAS-JL-L35138

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G61.9, Inflammatory polyneuropathy, unspecified