Does I70.25 require prior authorization?

No, I70.25 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.25`, Atherosclerosis of native arteries of other extremities with ulceration

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The medical record must clearly document that the coverage indications, limitations, and medical necessity criteria in L37228 Wound Care have been met for any billed wound care item or service.
Documentation must support the specific CPT/HCPCS code(s) billed, including procedure details, depth and surface area for debridement codes, and rationale for the service.
When hydrotherapy (whirlpool) is billed with CPT 97597 or 97598, the record must state why hydrotherapy was necessary to remove devitalized/necrotic tissue and that a therapist's skill was required to perform the service.

Key Coverage Criteria

Traditional negative pressure wound therapy (NPWT) devices, units, and supplies are covered under the Durable Medical Equipment (DME) benefit when they meet DME LCD coverage criteria and medical necessity.
CPT codes 97597, 97598, and wound debridement codes 11042-11047 may be covered when the medical record documents medical necessity consistent with L37228 Wound Care criteria and Medicare reasonable-and-necessary requirements.
Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.

20 Active Policies

CGS-J15-L34032, Debridement Services

J15

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

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

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

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

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

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L34032, Debridement Services

J18

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

J18

A57590, Billing and Coding: Non-Coronary Vascular Stents

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

WPS-J5-L37228, Wound Care

WPS-J5-L35998, Non-Coronary Vascular Stents

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

A55909, Billing and Coding: Wound Care

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

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

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

NGS-J6-L33627, Non-Invasive Vascular Studies

`I70.25`, Atherosclerosis of native arteries of other extremities with ulceration

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.25, Atherosclerosis of native arteries of other extremities with ulceration

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.25`, Atherosclerosis of native arteries of other extremities with ulceration