Does I87.011 require prior authorization?

No, I87.011 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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`I87.011`, Postthrombotic syndrome with ulcer 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.
Traditional negative pressure wound therapy (NPWT) devices, units, and supplies are covered under the Durable Medical Equipment (DME) benefit when they meet DME LCD coverage criteria and medical necessity.
CPT codes 97597, 97598, and wound debridement codes 11042-11047 may be covered when the medical record documents medical necessity consistent with L37228 Wound Care criteria and Medicare reasonable-and-necessary requirements.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L36690, Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities

J15

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L36690, Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L34032, Debridement Services

J18

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

WPS-J5-L34536, Treatment of Varicose Veins of the Lower Extremities

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

A55909, Billing and Coding: Wound Care

A56914, Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

WPS-J5-L37228, Wound Care

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

A56566, Billing and Coding: Outpatient Physical and Occupational Therapy Services

WPS-J8-L37228, Wound Care

WPS-J8-L34536, Treatment of Varicose Veins of the Lower Extremities

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

A56644, Billing and Coding: Endovenous Stenting

`I87.011`, Postthrombotic syndrome with ulcer of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I87.011, Postthrombotic syndrome with ulcer of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I87.011`, Postthrombotic syndrome with ulcer of right lower extremity