Does L03.039 require prior authorization?

No, L03.039 does not require prior authorization (high confidence). Covered without prior authorization.

`L03.039`, Cellulitis of unspecified toe

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Total the number of keratotic lesions debrided and select the most appropriate CPT code 11055-11057 based on that total (example: code 11056 for two to four lesions).

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.
Coverage may be allowed when the patient has Amyotrophic Lateral Sclerosis (ALS) resulting in a need for routine foot care.
Coverage may be allowed when the patient has arteritis of the feet resulting in a need for routine foot care.
Routine foot care is generally excluded from Medicare coverage but may be covered when a systemic condition justifies the need for routine foot care as defined in CMS manuals.
Coverage may be allowed when the patient has chronic indurated cellulitis of the feet resulting in a need for routine foot care.
Coverage may be allowed when the patient has chronic venous insufficiency resulting in a need for routine foot care.

NOVITAS-JH-L35138, Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

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