Does I70.221 require prior authorization?

No, I70.221 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`I70.221`, Atherosclerosis of native arteries of extremities with rest pain, right leg

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document the clinical findings supporting the billed foot care service and be available upon request.
Claims based on systemic-condition diagnosis codes with an asterisk must include the date patient was last seen (DPLS) and the NPI of the M.D. or D.O. actively managing the systemic condition in the medical record and/or claim.
Claims asserting presumptive coverage or systemic-condition exceptions must include the systemic-condition diagnosis code (Group 1) and the valid billing modifier (Q7/Q8/Q9) on the claim.

Key Coverage Criteria

Foot care services are covered when the beneficiary has a listed systemic condition that justifies coverage per Medicare Benefit Policy Manual Pub.100-02, Ch.15, Section 290.4D.
For diagnosis codes designated by an asterisk, the patient must be under the active care of an M.D. or D.O., documented as having been seen for the complicating disease within the 6 months prior to service.
Claims asserting presumptive coverage must include a systemic-condition diagnosis from IOM 100-02 Ch.15 Section 290 Group 1 and a valid billing modifier Q7, Q8, or Q9.
Mycotic nail debridement is covered when mycotic nails are present in the context of a systemic disease with class findings and the appropriate Q modifier on the claim.
Mycotic nail debridement is covered without systemic disease if an ambulatory patient has marked limitation of ambulation, pain, or secondary infection from thickened/dystrophic infected toenail plate.
Mycotic nail debridement is covered without systemic disease if a non-ambulatory patient has mycotic nails and suffers pain or secondary infection due to thickening and dystrophy of the infected toenail plate.

20 Active Policies

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

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

J15

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

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

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

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

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

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

WPS-J5-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

A57590, Billing and Coding: Non-Coronary Vascular Stents

WPS-J5-L35998, Non-Coronary Vascular Stents

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

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

A57591, Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

A56232, Billing and Coding: Foot Care

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

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

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

NGS-J6-L33636, Routine Foot Care and Debridement of Nails

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

`I70.221`, Atherosclerosis of native arteries of extremities with rest pain, right leg

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.221, Atherosclerosis of native arteries of extremities with rest pain, right leg

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.221`, Atherosclerosis of native arteries of extremities with rest pain, right leg