Does I70.239 require prior authorization?

No, I70.239 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`I70.239`, Atherosclerosis of native arteries of right leg with ulceration of unspecified site

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium 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).
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.
CPT 97032 (attended/manual electrical stimulation) is covered when delivered with direct 1-on-1 contact by qualified personnel (examples: direct motor point stimulation; FES/NMES when performed with therapeutic exercise, neuromuscular reeducation, or functional activities).
CPT 97032 may be billed for the application, instruction, and adjustment of a TENS unit or other probe-based stimulation (including determining trigger points) when provided as an attended/manual modality.

20 Active Policies

A56232, Billing and Coding: Foot Care

A56758, Billing and Coding: Non-Invasive Vascular Studies

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

A56566, Billing and Coding: Outpatient Physical and Occupational Therapy Services

NGS-J6-L33627, Non-Invasive Vascular Studies

A57064, Billing and Coding: Duplex Scan of Lower Extremity Arteries

A57636, Billing and Coding: Duplex Scanning

FIRST_COAST-L33674, Duplex Scanning

FIRST_COAST-L33941, Routine Foot Care

NOVITAS-JH-L35138, Routine Foot Care

NGS-JK-L33627, Non-Invasive Vascular Studies

NGS-JK-L33557, Cardiac Catheterization and Coronary Angiography

A52996, Billing and Coding: Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

A58565, Billing and Coding: Wound and Ulcer Care

A53064, Billing and Coding: Outpatient Occupational Therapy

A56680, Billing and Coding: Routine Foot Care

A57067, Billing and Coding: Outpatient Physical and Occupational Therapy Services

A57188, Billing and Coding: Routine Foot Care

`I70.239`, Atherosclerosis of native arteries of right leg with ulceration of unspecified site

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.239, Atherosclerosis of native arteries of right leg with ulceration of unspecified site

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.239`, Atherosclerosis of native arteries of right leg with ulceration of unspecified site