Does I70.468 require prior authorization?

No, I70.468 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.468`, Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, other extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The medical record must clearly document that the coverage indications, limitations, and medical necessity criteria in L37228 Wound Care have been met for any billed wound care item or service.
Documentation must support the specific CPT/HCPCS code(s) billed, including procedure details, depth and surface area for debridement codes, and rationale for the service.
When hydrotherapy (whirlpool) is billed with CPT 97597 or 97598, the record must state why hydrotherapy was necessary to remove devitalized/necrotic tissue and that a therapist's skill was required to perform the service.

Key Coverage Criteria

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.
Coverage for non-emergent outpatient stress testing is subject to the reasonable and necessary requirements in Local Coverage Determination L35083 and is allowed only when L35083 clinical criteria are met.
MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.

20 Active Policies

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J18-L34062, Dialysis Access Maintenance

J18

WPS-J5-L37228, Wound Care

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

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

A55909, Billing and Coding: Wound Care

NGS-J6-L33627, Non-Invasive Vascular Studies

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

A56758, Billing and Coding: Non-Invasive Vascular Studies

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

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

WPS-J8-L37228, Wound Care

FIRST_COAST-L36767, Aortography and peripheral angiography

FIRST_COAST-L38396, Cardiology Non-emergent Outpatient Stress Testing

A57056, Billing and Coding: Aortography and Peripheral Angiography

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

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

NGS-JK-L33627, Non-Invasive Vascular Studies

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

A56423, Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing

`I70.468`, Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.468, Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.468`, Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, other extremity