Does I70.208 require prior authorization?

No, I70.208 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.208`, Unspecified atherosclerosis of native arteries of extremities, other extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high 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.

When reporting an ICD-10-CM code that falls under the active care requirement, report the date the beneficiary was last seen by the MD, DO, or qualified NPP responsible for treating the underlying condition in line 19 of the CMS-1500 or the electronic equivalent.

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.
Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.
Immediate post-operative studies of an access or bypass site are covered if pulses are lost, become equivocal, or the patient develops signs or symptoms of ischemia suggesting need for repeat intervention.

20 Active Policies

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

CGS-J15-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J15

CGS-J18-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J18

CGS-J18-L34246, Routine Foot Care and Debridement of Nails

J18

A57593, Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

WPS-J5-L35761, Non-Invasive Peripheral Arterial Vascular Studies

WPS-J5-L36523, MolDX: Biomarkers in Cardiovascular Risk Assessment

A57559, Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

A56758, Billing and Coding: Non-Invasive Vascular Studies

NGS-J6-L33627, Non-Invasive Vascular Studies

WPS-J8-L36523, MolDX: Biomarkers in Cardiovascular Risk Assessment

WPS-J8-L35761, Non-Invasive Peripheral Arterial Vascular Studies

FIRST_COAST-L33941, Routine Foot Care

FIRST_COAST-L33674, Duplex Scanning

A57636, Billing and Coding: Duplex Scanning

NOVITAS-JH-L35138, Routine Foot Care

NGS-JK-L33627, Non-Invasive Vascular Studies

A52996, Billing and Coding: Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

A56775, Billing and Coding: Magnetic Resonance Angiography

`I70.208`, Unspecified atherosclerosis of native arteries of extremities, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.208, Unspecified atherosclerosis of native arteries of extremities, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.208`, Unspecified atherosclerosis of native arteries of extremities, other extremity