Does I83.12 require prior authorization?

No, I83.12 does not require prior authorization (high confidence). Covered without prior authorization.

`I83.12`, Varicose veins of left lower extremity with inflammation

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.
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.

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

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

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L34082, Varicose Veins of the Lower Extremity, Treatment of

J18

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