Does I70.401 require prior authorization?

No, I70.401 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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`I70.401`, Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg

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

The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.
When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim; for extra-cardiac angiographic services the treating physician's name and NPI must be submitted in items 17/17a of CMS-1500 or electronic equivalent.

Key Coverage Criteria

Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
Foot care services are covered when the beneficiary has a listed systemic condition that justifies coverage per Medicare Benefit Policy Manual Pub.100-02, Ch.15, Section 290.4D.
For diagnosis codes designated by an asterisk, the patient must be under the active care of an M.D. or D.O., documented as having been seen for the complicating disease within the 6 months prior to service.
Claims asserting presumptive coverage must include a systemic-condition diagnosis from IOM 100-02 Ch.15 Section 290 Group 1 and a valid billing modifier Q7, Q8, or Q9.

20 Active Policies

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J18-L34062, Dialysis Access Maintenance

J18

A57590, Billing and Coding: Non-Coronary Vascular Stents

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

WPS-J5-L35998, Non-Coronary Vascular Stents

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

A56232, Billing and Coding: Foot Care

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

WPS-J8-L35998, Non-Coronary Vascular Stents

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

A57056, Billing and Coding: Aortography and Peripheral Angiography

FIRST_COAST-L36767, Aortography and peripheral angiography

NGS-JK-L33557, Cardiac Catheterization and Coronary Angiography

A56775, Billing and Coding: Magnetic Resonance Angiography

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

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

A56460, Billing and Coding: Dialysis Access Maintenance

A56476, Billing and Coding: Cardiac Radionuclide Imaging

A56675, Billing and Coding: Homocysteine Level, Serum

`I70.401`, Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.401, Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.401`, Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg