Does I82.561 require prior authorization?

No, I82.561 does not require prior authorization (high confidence). Covered without prior authorization.

`I82.561`, Chronic embolism and thrombosis of right calf muscular vein

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must contain relevant medical history, physical examination, and results of pertinent diagnostic tests that fully support the medical necessity of each non-invasive vascular study.
Diagnostic tests must be ordered by the treating practitioner (or consulting physician) who will use the test results in managing the patient's specific medical problem; the ordering practitioner's name and NPI must be reported on the claim when required.
Providers of interpretations and technical personnel must maintain documentation of training, licensure, certification, and proficiency for post-payment audit; IDTF supervising physicians must document proficiency in each diagnostic procedure performed.
For diagnostic tests, report the test result if known; if not known, report the symptoms prompting the test on the claim.

Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.
Immediate post-operative studies of an access or bypass site are covered if pulses are lost, become equivocal, or the patient develops signs or symptoms of ischemia suggesting need for repeat intervention.
Doppler ultrasound (CPT 93971) is the current standard for preoperative evaluation of venous reflux in patients with chronic venous insufficiency.

CGS-J15-L40258, MolDX: Genetic Testing for Hereditary Thrombophilia

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

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

J15

CGS-J18-L40258, MolDX: Genetic Testing for Hereditary Thrombophilia

J18

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