Does I70.398 require prior authorization?

No, I70.398 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.398`, Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims for stress tests performed as preoperative evaluation of asymptomatic, moderate-risk patients must include medical record documentation of at least one of: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
Medical record must document suspected B12 or folate deficiency or the specific ICD-10-CM code from LCD L34419 supporting risk stratification medical necessity.
For repeat testing, medical records must document prior appropriate treatment and objective evidence that the treatment did not correct the anemia or symptoms.

For ICD-10-CM codes designated with an asterisk, the patient must be under the active care of a MD/DO who documents the condition and the claim must include the attending physician's name and NPI in CMS-1500 blocks 17/17B, the date patient was last seen (DPLS) in block 19, and the complicating systemic disease in block 21.

Key Coverage Criteria

Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
Serum homocysteine testing is covered for evaluation of suspected vitamin B12 (cobalamin) deficiency.
Serum homocysteine testing is covered for risk stratification for the conditions listed in the ICD-10-CM Codes that Support Medical Necessity in LCD L34419.
Serum homocysteine testing is covered for evaluation of suspected folate (vitamin B9) deficiency.
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 [...]

5 Active Policies

A56476, Billing and Coding: Cardiac Radionuclide Imaging

A56675, Billing and Coding: Homocysteine Level, Serum

A56680, Billing and Coding: Routine Foot Care

A56775, Billing and Coding: Magnetic Resonance Angiography

A60247, Billing and Coding: Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

`I70.398`, Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

I70.398, Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`I70.398`, Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity