Does G71.036 require prior authorization?

No, G71.036 does not require prior authorization (high confidence). Covered without prior authorization.

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`G71.036`, Limb girdle muscular dystrophy due to fukutin related protein dysfunction

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

A face-to-face encounter and a Written Order Prior to Delivery (WOPD) are required for specified HCPCS codes under Final Rule 1713 and must be obtained prior to delivery per the LCD-related Standard Documentation Requirements (Article A55426).
The diagnosis code that justifies the need for the HFCWO item must be included on the claim.
The beneficiary's medical record must describe the underlying medical condition(s) causing accumulation of pulmonary secretions, prior and current treatment interventions (e.g., chest physiotherapy, postural drainage, medications, mechanical modalities such as in-exsufflation devices), and the effectiveness of those treatments; this information must be available upon request.

Key Coverage Criteria

High Frequency Chest Wall Oscillation (HFCWO) devices (HCPCS E0483) are covered under the Durable Medical Equipment benefit when the device is reasonable and necessary for the beneficiary per the related Local Coverage Determination (LCD) and all applicable Medicare statutory and regulatory requirements are met.
Mechanical in-exsufflation devices are covered under the Durable Medical Equipment (DME) benefit when the beneficiary meets the reasonable and necessary (R&N) requirements specified in the related Local Coverage Determination (LCD).
Replacement reimbursement for HCPCS A7020 is allowed only if the beneficiary owns or is purchasing the mechanical in-exsufflation device and the claim includes the diagnosis code that justifies medical need.
Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.
Electrical stimulation (attended CPT 97032 or unattended HCPCS G0283) may be covered as part of a therapy plan of care to improve function when the nerve supply to the muscle is intact and atrophy is due to non-neurological disuse (e.g., post-casting, splinting, soft-tissue scarring).
Wheelchair management training (CPT 97542) is covered for patient and/or caregiver training in transfers and propulsion when documentation ties the training to attainable functional goals.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

A52494, High Frequency Chest Wall Oscillation Devices - Policy Article

A52510, Mechanical In-exsufflation Devices - Policy Article

A53057, Billing and Coding: Home Health Occupational Therapy

A53058, Billing and Coding: Home Health Physical Therapy

A53064, Billing and Coding: Outpatient Occupational Therapy

A53065, Billing and Coding: Outpatient Physical Therapy

CIGNA-0069, Airway Clearance Devices in the Ambulatory Setting

A56500, Billing and Coding: Cardiac Catheterization and Coronary Angiography

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A56621, Billing and Coding: Swallowing Studies for Dysphagia

`G71.036`, Limb girdle muscular dystrophy due to fukutin related protein dysfunction

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G71.036, Limb girdle muscular dystrophy due to fukutin related protein dysfunction

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G71.036`, Limb girdle muscular dystrophy due to fukutin related protein dysfunction