Does I74.3 require prior authorization?

No, I74.3 does not require prior authorization (high confidence). Code is covered without prior authorization.

`I74.3`, Embolism and thrombosis of arteries of the lower extremities

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Billing and coding guidance for non-coronary vascular stents is dependent on the coverage indications, limitations, and medical necessity specified in the related Local Coverage Determination (LCD); consult the related LCD for the specific coverage and coding requirements.
A permanent record of the studies performed and the interpretation must be maintained in the medical record.
Documentation must include a description of the studies performed, any contrast media or radiopharmaceuticals used, any known significant patient reactions or complications, comparisons with prior relevant studies, and both normal and abnormal findings with measurements of variations from normal.
The report should address specific clinical questions or explain factors that prevent answering those questions.

Non-invasive peripheral arterial vascular studies are covered when the study results will be used in the clinical management of the patient and the medical necessity is documented in the medical record.
One preoperative non-invasive vascular scan for bypass surgery is reasonable and covered to guide surgical planning.
Immediate postoperative studies are covered when re-established pulses are lost or become equivocal, or the patient develops signs or symptoms of ischemia suggesting impending repeat intervention.
Medically necessary follow-up noninvasive studies after angioplasty are covered, with the follow-up frequency determined by the vascular distribution treated and documented medical necessity.
Duplex scanning and physiologic studies performed during the same encounter may be covered when the physiologic studies are abnormal and/or to evaluate vascular trauma, thromboembolic events, or aneurysmal disease, with documentation supporting medical necessity.
Pre-surgical radial artery mapping may be performed, and accompanying vein-mapping is covered only when the arterial studies demonstrate a non-acceptable conduit or there is insufficient arterial conduit for multiple bypass procedures.

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J15-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

Ask Backwork about documentation requirements, denial risks, or coverage in your state.