Does G71.038 require prior authorization?

No, G71.038 does not require prior authorization (high confidence). Covered without prior authorization.

`G71.038`, Other limb girdle muscular dystrophy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

A face-to-face encounter and a Written Order Prior to Delivery (WOPD) are required for specified HCPCS codes pursuant to Final Rule 1713 and must be obtained prior to delivery per the LCD-related Standard Documentation Requirements (A55426).
For reimbursement of replacement A7020, the claim must include the diagnosis code that justifies the need for the interface.
Suppliers must follow the general documentation requirements in the LCD and the LCD-related Standard Documentation Requirements Article; refer to the related local coverage documents for full policy-specific documentation details.
Suppliers should contact the PDAC contractor for guidance on correct coding of mechanical in-exsufflation items.

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.
Therapeutic exercise (CPT 97110) is covered when used to address impairments of exercise tolerance due to cardiopulmonary impairments.

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

Ask Backwork about documentation requirements, denial risks, or coverage in your state.