Does I70.613 require prior authorization?

No, I70.613 does not require prior authorization (high confidence). Covered without prior authorization.

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`I70.613`, Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document the clinical findings supporting the billed foot care service and be available upon request.
Claims based on systemic-condition diagnosis codes with an asterisk must include the date patient was last seen (DPLS) and the NPI of the M.D. or D.O. actively managing the systemic condition in the medical record and/or claim.
Claims asserting presumptive coverage or systemic-condition exceptions must include the systemic-condition diagnosis code (Group 1) and the valid billing modifier (Q7/Q8/Q9) on the claim.

Key Coverage Criteria

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.
Mycotic nail debridement is covered when mycotic nails are present in the context of a systemic disease with class findings and the appropriate Q modifier on the claim.
Mycotic nail debridement is covered without systemic disease if an ambulatory patient has marked limitation of ambulation, pain, or secondary infection from thickened/dystrophic infected toenail plate.
Mycotic nail debridement is covered without systemic disease if a non-ambulatory patient has mycotic nails and suffers pain or secondary infection due to thickening and dystrophy of the infected toenail plate.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

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

A56232, Billing and Coding: Foot Care

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

WPS-J5-L35998, Non-Coronary Vascular Stents

A57590, Billing and Coding: Non-Coronary Vascular Stents

A56758, Billing and Coding: Non-Invasive Vascular Studies

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

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

NGS-J6-L33627, Non-Invasive Vascular Studies

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

WPS-J8-L35998, Non-Coronary Vascular Stents

FIRST_COAST-L40289, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

A57056, Billing and Coding: Aortography and Peripheral Angiography

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

FIRST_COAST-L40288, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

FIRST_COAST-L38396, Cardiology Non-emergent Outpatient Stress Testing

FIRST_COAST-L36767, Aortography and peripheral angiography

FIRST_COAST-L33693, Peripheral Venous Ultrasound

`I70.613`, Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I70.613, Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I70.613`, Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs