Does I70.298 require prior authorization?

No, I70.298 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.298`, Other 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.
Coverage for non-emergent outpatient stress testing is subject to the reasonable and necessary requirements in Local Coverage Determination L35083 and is allowed only when L35083 clinical criteria are met.
CPT 78434 (gated SPECT) may be reported only in conjunction with CPT 78431 or CPT 78492 when billed for SPECT myocardial perfusion imaging (MPI).
SPECT MPI includes routine evaluation of left ventricular wall motion and left ventricular ejection fraction (LVEF) as part of the MP1 service definition.
Non-invasive peripheral arterial vascular studies are covered when the study results will be used in the clinical management of the patient and the medical necessity is documented in the medical record.
One preoperative non-invasive vascular scan for bypass surgery is reasonable and covered to guide surgical planning.

20 Active Policies

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

J15

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

J18

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

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

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

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

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

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

FIRST_COAST-L33674, Duplex Scanning

FIRST_COAST-L38396, Cardiology Non-emergent Outpatient Stress Testing

A57636, Billing and Coding: Duplex Scanning

A56952, Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing

NOVITAS-JH-L35083, Cardiology Non-emergent Outpatient Stress Testing

NOVITAS-JH-L35138, Routine Foot Care

A56423, Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing

NOVITAS-JL-L35083, Cardiology Non-emergent Outpatient Stress Testing

NOVITAS-JL-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

A56943, Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

A56775, Billing and Coding: Magnetic Resonance Angiography

`I70.298`, Other 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?

I70.298, Other 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?

`I70.298`, Other atherosclerosis of native arteries of extremities, other extremity