Does O24.811 require prior authorization?

No, O24.811 does not require prior authorization (high confidence). Covered without prior authorization.

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`O24.811`, Other pre-existing diabetes mellitus in pregnancy, first trimester

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

When reporting an ICD-10-CM code that falls under the active care requirement, report the date the beneficiary was last seen by the MD, DO, or qualified NPP responsible for treating the underlying condition in line 19 of the CMS-1500 or the electronic equivalent.

Key Coverage Criteria

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.

20 Active Policies

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

J15

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

J18

WPS-J5-L38686, Implantable Continuous Glucose Monitors (I-CGM)

WPS-J5-L35490, Category III Codes

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

NGS-J6-L38623, Implantable Continuous Glucose Monitors (I-CGM)

A58116, Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

WPS-J8-L38686, Implantable Continuous Glucose Monitors (I-CGM)

WPS-J8-L35490, Category III Codes

FIRST_COAST-L38664, Implantable Continuous Glucose Monitors (I-CGM)

A58136, Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

NOVITAS-JH-L35138, Routine Foot Care

NOVITAS-JH-L38617, Implantable Continuous Glucose Monitors (I-CGM)

NGS-JK-L38623, Implantable Continuous Glucose Monitors (I-CGM)

A52996, Billing and Coding: Routine Foot Care

NOVITAS-JL-L38617, Implantable Continuous Glucose Monitors (I-CGM)

A58110, Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

NOVITAS-JL-L35138, Routine Foot Care

ANTHEM-CG-RAD-26, Maternity Ultrasound in the Outpatient Setting

A58277, Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

`O24.811`, Other pre-existing diabetes mellitus in pregnancy, first trimester

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

O24.811, Other pre-existing diabetes mellitus in pregnancy, first trimester

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`O24.811`, Other pre-existing diabetes mellitus in pregnancy, first trimester