Does I70.334 require prior authorization?

No, I70.334 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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`I70.334`, Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot

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

For CPT 97032, document the type of electrical stimulation (including 'manual'/'attended'), area(s) treated, and if used for muscle weakness provide objective strength ratings and functional deficits; if used for pain provide pain rating, pain location, and effect on function.
For HCPCS G0283, document the type of electrical stimulation (e.g., TENS, IFC), area(s) treated, and objective/subjective measures showing impact on pain intensity/location/functional impact and/or swelling.
For non-implantable pelvic floor stimulation, document cognitive intactness, patient motivation, and a failed documented trial of PME training (defined as no clinically significant improvement after 4 weeks of an ordered PME plan).

Key Coverage Criteria

Attended/manual electrical stimulation (CPT 97032) is covered when the qualified professional provides direct 1-on-1 patient contact to apply/manualy adjust stimulation (e.g., direct motor point stimulation, FES/NMES when combined with therapeutic exercise/neuromuscular reeducation/functional activities).
Non-implantable pelvic floor electrical stimulation delivered via vaginal or anal probes (reportable as CPT 97032) is covered for stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
Unattended/supervised electrical stimulation provided as part of a therapy plan of care (HCPCS G0283) is covered for non-wound indications (e.g., TENS, IFC, cyclical muscle stimulation) when used to control pain and/or swelling and when objective/subjective improvement is documented.
Electromagnetic therapy (HCPCS G0329) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.
Unattended electrical stimulation for wound management (HCPCS G0281) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not shown measurable healing after 30 days of conventional care.
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.

20 Active Policies

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-L34045, Non-Invasive Vascular Studies

J18

A55909, Billing and Coding: Wound Care

WPS-J5-L35998, Non-Coronary Vascular Stents

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

WPS-J5-L37228, Wound Care

A56232, Billing and Coding: Foot Care

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

A57590, Billing and Coding: Non-Coronary Vascular Stents

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

WPS-J8-L37228, Wound Care

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

WPS-J8-L35998, Non-Coronary Vascular Stents

NOVITAS-JH-L34865, Magnetic Resonance Angiography (MRA)

A56805, Billing and Coding: Magnetic Resonance Angiography (MRA)

NOVITAS-JL-L34865, Magnetic Resonance Angiography (MRA)

A53065, Billing and Coding: Outpatient Physical Therapy

A56675, Billing and Coding: Homocysteine Level, Serum

`I70.334`, Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.334, Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.334`, Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot