Does I70.45 require prior authorization?

No, I70.45 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.45`, Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high 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).
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.
CPT codes 97597, 97598, and wound debridement codes 11042-11047 may be covered when the medical record documents medical necessity consistent with L37228 Wound Care criteria and Medicare reasonable-and-necessary requirements.
MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.

20 Active Policies

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34062, Dialysis Access Maintenance

J18

A55909, Billing and Coding: Wound Care

WPS-J5-L37228, Wound Care

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

NGS-J6-L33627, Non-Invasive Vascular Studies

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

A56758, Billing and Coding: Non-Invasive Vascular Studies

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

WPS-J8-L37228, Wound Care

FIRST_COAST-L36767, Aortography and peripheral angiography

FIRST_COAST-L38396, Cardiology Non-emergent Outpatient Stress Testing

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

A57056, Billing and Coding: Aortography and Peripheral Angiography

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

`I70.45`, Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.45, Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.45`, Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration