Does I87.301 require prior authorization?

No, I87.301 does not require prior authorization (high confidence). Covered without prior authorization.

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`I87.301`, Chronic venous hypertension (idiopathic) without complications of right lower extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When routine foot care needs to meet one of the exclusions, include the applicable Q modifier on the claim: Q7 for 1 Class A finding, Q8 for 2 Class B findings, and Q9 for 1 Class B plus 2 Class C findings.
For all foot-care claims report an appropriate foot/toe location modifier (e.g., LT, RT, TA, T1-T9) to identify laterality and specific toe when applicable.
If a significant, separately identifiable evaluation and management service is provided on the same day as routine foot care, append modifier -25 to the E/M claim line.

When reporting an ICD-10-CM code that falls under the active care requirement, report the date the beneficiary was last seen by the MD, DO, or qualified NPP responsible for treating the underlying condition in line 19 of the CMS-1500 or the electronic equivalent.

Key Coverage Criteria

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.
CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).
For congenital anomalies, use CPT code 93315 (HCPCS C8926 for OPPS billing) for the complete contrast TEE procedure.
Hospitals should bill echocardiograms without contrast using the applicable Level 1 CPT code descriptors and guidelines.
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

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

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

A56758, Billing and Coding: Non-Invasive Vascular Studies

NGS-J6-L33627, Non-Invasive Vascular Studies

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

NOVITAS-JH-L35016, Transesophageal Echocardiography (TEE)

NOVITAS-JH-L35138, Routine Foot Care

NGS-JK-L33627, Non-Invasive Vascular Studies

NOVITAS-JL-L35016, Transesophageal Echocardiography (TEE)

A56505, Billing and Coding: Transesophageal Echocardiography (TEE)

A52996, Billing and Coding: Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

A56697, Billing and Coding: Non-Invasive Vascular Studies

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

`I87.301`, Chronic venous hypertension (idiopathic) without complications of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

I87.301, Chronic venous hypertension (idiopathic) without complications of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`I87.301`, Chronic venous hypertension (idiopathic) without complications of right lower extremity