Does I70.299 require prior authorization?

No, I70.299 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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`I70.299`, Other atherosclerosis of native arteries of extremities, unspecified extremity

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

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.

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.
Nail debridement (CPT 11720 or 11721) for mycotic nails is covered when billed with ICD-10-CM B35.1 as the primary diagnosis and one of the following as a secondary diagnosis: L02.611, L02.612, L03.031, L03.032, L03.041, L03.042, M79.671, M79.672, M79.674, M79.675, or R26.2.
Routine foot care services are covered when the patient has one of the specified systemic conditions (e.g., diabetes mellitus; arteriosclerosis obliterans; Buerger's disease; chronic thrombophlebitis; peripheral neuropathies of the feet including those associated with malnutrition, alcoholism, malabsorption, pernicious anemia, carcinoma, drugs/toxins, multiple sclerosis, uremia, traumatic injury, leprosy/neurosyphilis, hereditary disorders including hereditary sensory radicular neuropathy, Fabry [...]
A presumption of coverage for routine foot care exists when the physician rendering the service documents and bills using modifier Q7 (one Class A finding), Q8 (two Class B findings), or Q9 (one Class B plus two Class C findings) and a systemic condition diagnosis from the listed conditions is present.
Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
Duplex scanning is covered to evaluate suspected chronic intestinal ischemia in patients with postprandial epigastric or periumbilical pain lasting 1–3 hours and associated weight loss from decreased oral intake.

7 Active Policies

FIRST_COAST-L33674, Duplex Scanning

A57636, Billing and Coding: Duplex Scanning

NOVITAS-JH-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

ANTHEM-MP-B094276, TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products

A56680, Billing and Coding: Routine Foot Care

`I70.299`, Other atherosclerosis of native arteries of extremities, unspecified extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

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I70.299, Other atherosclerosis of native arteries of extremities, unspecified extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`I70.299`, Other atherosclerosis of native arteries of extremities, unspecified extremity