Does I80.3 require prior authorization?

No, I80.3 does not require prior authorization (high confidence). Covered without prior authorization.

`I80.3`, Phlebitis and thrombophlebitis of lower extremities, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code must best describe the patient's condition for the service performed.
The patient's medical record must contain documentation fully supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Medical record must document history and physical findings supporting a diagnosis of symptomatic varicose veins.
Medical record must document failure of an adequate trial of conservative treatment as described in the LCD.

Interventional treatments are covered for symptomatic varicose veins of the lower extremity when the medical record documents history and physical findings supporting the diagnosis.
Coverage requires failure of an adequate trial of conservative treatment prior to interventional therapy as described in the LCD.
Coverage requires exclusion of other causes of limb edema, ulceration, and pain prior to treatment of varicose veins.
Coverage requires performance of appropriate diagnostic testing (e.g., duplex ultrasound) to confirm the presence and location of incompetent perforating veins when indicated.
Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
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.

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34082, Varicose Veins of the Lower Extremity, Treatment of

J15

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

CGS-J18-L34246, Routine Foot Care and Debridement of Nails

J18

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