Does I70.598 require prior authorization?

No, I70.598 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.598`, Other atherosclerosis of nonautologous biological 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

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).
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).

20 Active Policies

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J18-L34062, Dialysis Access Maintenance

J18

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

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

A56758, Billing and Coding: Non-Invasive Vascular Studies

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

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

NGS-J6-L33627, Non-Invasive Vascular Studies

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

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

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

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-L33557, Cardiac Catheterization and Coronary Angiography

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

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

`I70.598`, Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.598, Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.598`, Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity