Does O24.13 require prior authorization?

No, O24.13 does not require prior authorization (high confidence). Covered without prior authorization.

`O24.13`, Pre-existing type 2 diabetes mellitus, in the puerperium

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 for implantable continuous glucose monitor (I-CGM) procedures is allowed when reasonable and necessary per Local Coverage Determination L38617.
Insertion of an implantable interstitial glucose sensor (report CPT 0446T) for 90-day, 180-day, or 365-day sensors is covered when the procedure meets LCD L38617 reasonable and necessary requirements.
Removal of an implantable interstitial glucose sensor (report CPT 0447T) is covered when device removal is clinically indicated and documented.
Removal with immediate subsequent replacement at a different anatomic site (report CPT 0448T) is covered when clinically indicated and documented.
Replacement of a 90-day sensor with a 365-day sensor is allowed when one or more of the following is documented: patient discomfort or need for a different anatomical site, sensor has reached end of functional life, or provider documents sensor malfunction and recommends replacement.

CGS-J15-L38662, Implantable Continuous Glucose Monitors (I-CGM)

J15

CGS-J18-L38662, Implantable Continuous Glucose Monitors (I-CGM)

J18

WPS-J5-L35490, Category III Codes

A58213, Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

Ask Backwork about documentation requirements, denial risks, or coverage in your state.