Does I87.001 require prior authorization?

No, I87.001 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`I87.001`, Postthrombotic syndrome without complications of right lower extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

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 performance of appropriate tests to confirm the presence and location of incompetent perforating veins (e.g., duplex ultrasound) and the location, number, and level of incompetence of veins involved.

Key Coverage Criteria

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.
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.

16 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

WPS-J5-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

A57594, Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

A52870, Billing and Coding: Treatment of Varicose Veins of the Lower Extremity

NGS-J6-L33627, Non-Invasive Vascular Studies

A56758, Billing and Coding: Non-Invasive Vascular Studies

WPS-J8-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

NOVITAS-JH-L35138, Routine Foot Care

NGS-JK-L33627, Non-Invasive Vascular Studies

NOVITAS-JL-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

A57706, Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

A57305, Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of

A56697, Billing and Coding: Non-Invasive Vascular Studies

A57954, Billing and Coding: Routine Foot Care

`I87.001`, Postthrombotic syndrome without complications of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

I87.001, Postthrombotic syndrome without complications of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`I87.001`, Postthrombotic syndrome without complications of right lower extremity