Does I70.228 require prior authorization?

No, I70.228 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.228`, Atherosclerosis of native arteries of extremities with rest pain, other extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.
When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim; for extra-cardiac angiographic services the treating physician's name and NPI must be submitted in items 17/17a of CMS-1500 or electronic equivalent.

Key Coverage Criteria

Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.

20 Active Policies

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

J15

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

J15

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

J18

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

J18

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

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

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

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

A57590, Billing and Coding: Non-Coronary Vascular Stents

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

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

WPS-J5-L35998, Non-Coronary Vascular Stents

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

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

A56758, Billing and Coding: Non-Invasive Vascular Studies

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

NGS-J6-L33627, Non-Invasive Vascular Studies

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

WPS-J8-L35998, Non-Coronary Vascular Stents

`I70.228`, Atherosclerosis of native arteries of extremities with rest pain, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.228, Atherosclerosis of native arteries of extremities with rest pain, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.228`, Atherosclerosis of native arteries of extremities with rest pain, other extremity