Does M31.0 require prior authorization?

No, M31.0 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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`M31.0`, Hypersensitivity angiitis

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

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
Billing and coding for pulmonary stress testing must follow Local Coverage Determination (LCD) L33444; consult LCD L33444 for specific medical necessity, coding, and billing criteria.
This article provides billing, coding, or other guidelines that complement LCD L33444 rather than standalone coverage criteria.
A permanent record of the studies performed and the interpretation must be maintained in the medical record.

Key Coverage Criteria

Non-invasive peripheral arterial vascular studies are covered when the study results will be used in the clinical management of the patient and the medical necessity is documented in the medical record.
One preoperative non-invasive vascular scan for bypass surgery is reasonable and covered to guide surgical planning.
Immediate postoperative studies are covered when re-established pulses are lost or become equivocal, or the patient develops signs or symptoms of ischemia suggesting impending repeat intervention.
Medically necessary follow-up noninvasive studies after angioplasty are covered, with the follow-up frequency determined by the vascular distribution treated and documented medical necessity.
Duplex scanning and physiologic studies performed during the same encounter may be covered when the physiologic studies are abnormal and/or to evaluate vascular trauma, thromboembolic events, or aneurysmal disease, with documentation supporting medical necessity.
Pre-surgical radial artery mapping may be performed, and accompanying vein-mapping is covered only when the arterial studies demonstrate a non-acceptable conduit or there is insufficient arterial conduit for multiple bypass procedures.

20 Active Policies

A59434, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

WPS-J5-L35761, Non-Invasive Peripheral Arterial Vascular Studies

A57593, Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

A58893, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

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M31.0, Hypersensitivity angiitis