Does R22.40 require prior authorization?

No, R22.40 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R22.40`, Localized swelling, mass and lump, unspecified lower limb

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

No explicit documentation requirements, covered diagnoses (ICD-10), or billing/coding lists are provided in this document.
The document references that studies and clinical use often rely on paired pre- and post-procedural angiography and IVUS imaging (e.g., VIDIO trial, TEVAR studies, coronary/ peripheral EVT studies), suggesting that procedural reports and IVUS imaging records would be pertinent for clinical decision-making and outcome assessment.
No specific documentation requirements (medical records, test results, or clinical notes) are specified in this document.
General: where selection criteria are required, documentation must support that selection criteria are met (policy repeatedly states CPT/ICD-10 codes are 'covered if selection criteria are met').

As a guidance for placement of vena caval filter;
Evaluation and management of cerebral venous disease with IVUS.
Other HCPCS codes related to the CPB: C1880 Vena cava filter
Other CPT codes related to the CPB: +92973 Percutaneous transluminal coronary thrombectomy (List separately in addition to code for primary procedure)
Other CPT codes related to the CPB: 92997 - 92998 Percutaneous transluminal pulmonary artery balloon angioplasty
Other HCPCS codes related to the CPB: C1753 Catheter, intravascular ultrasound

ANTHEM-CG-SURG-119, Treatment of Varicose Veins (Lower Extremities)

AETNA-CPB-0382, Intravascular Ultrasound

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