Does I87.311 require prior authorization?

No, I87.311 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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`I87.311`, Chronic venous hypertension (idiopathic) 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.
Skilled therapy services are covered when the skills of a qualified therapist are necessary to improve the patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration.
Rehabilitative therapy is covered when therapist skills are necessary to safely and effectively furnish a recognized therapy service with the goal of improving an impairment or functional limitation.

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-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

CGS-J18-L34032, Debridement Services

J18

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

J18

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

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

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

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

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

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

A56758, Billing and Coding: Non-Invasive Vascular Studies

NGS-J6-L33627, Non-Invasive Vascular Studies

NGS-J6-L33575, Varicose Veins of the Lower Extremity, Treatment of

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

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

FIRST_COAST-L38720, Treatment of Chronic Venous Insufficiency of the Lower Extremities

`I87.311`, Chronic venous hypertension (idiopathic) with ulcer of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I87.311, Chronic venous hypertension (idiopathic) with ulcer of right lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I87.311`, Chronic venous hypertension (idiopathic) with ulcer of right lower extremity