Does L97.229 require prior authorization?

No, L97.229 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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`L97.229`, Non-pressure chronic ulcer of left calf with unspecified severity

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

The final report must include an impression or summary statement, a specific or differential diagnosis if appropriate, and recommendations for follow-up when clinically applicable.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care.

Key Coverage Criteria

Doppler ultrasound (peripheral venous ultrasound) is the standard preoperative test to evaluate venous reflux in patients with chronic venous insufficiency.
CPT 93971 should be used to report either a limited bilateral duplex scan or a complete unilateral duplex scan for peripheral venous reflux evaluation.
CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
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.

11 Active Policies

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

FIRST_COAST-L33693, Peripheral Venous Ultrasound

A57125, Billing and Coding: Peripheral Venous Ultrasound

NOVITAS-JH-L35451, Peripheral Venous Ultrasound

NGS-JK-L33627, Non-Invasive Vascular Studies

A52993, Billing and Coding: Peripheral Venous Ultrasound

NOVITAS-JL-L35451, Peripheral Venous Ultrasound

A57067, Billing and Coding: Outpatient Physical and Occupational Therapy Services

A53058, Billing and Coding: Home Health Physical Therapy

`L97.229`, Non-pressure chronic ulcer of left calf with unspecified severity

Prior Authorization

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

L97.229, Non-pressure chronic ulcer of left calf with unspecified severity

Prior Authorization

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`L97.229`, Non-pressure chronic ulcer of left calf with unspecified severity