Does R58 require prior authorization?

No, R58 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R58`, Hemorrhage, not elsewhere classified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Maintain a complete, legible medical record with patient identification, dates of service, and the legible signature of the responsible physician or non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code(s) billed must describe the service performed.
Documentation must include a plan of care for a 90-day episode that supports evaluation including history, physical exam, CEAP clinical classification, VCSS, and a formal venous duplex scan.
The plan of care must outline timing of interventions versus routine post-procedure follow-up, list planned treatments (e.g., thermal ablation, sclerotherapy, cyanoacrylate/chemical adhesive, mechanochemical ablation, surgical treatments), and must be supported by complete operative procedure notes.

Injection sclerotherapy (CPT 36468) is appropriate for treatment of symptomatic spider veins / telangiectasia of the lower extremities.
Non-compounded foam (NCF) sclerotherapy is appropriate for treatment of incompetent extremity truncal veins (report with CPT 36465 or 36466).
NCF sclerotherapy for other incompetent extremity veins is reported with CPT 36470 or 36471.
Physician-compounded foam (PCF) sclerotherapy for treatment of incompetent extremity truncal and other incompetent extremity veins is reported with CPT 36470 or 36471.
Treatment (sclerotherapy, surgical ligation/stripping, ablation) of varicose veins of the lower extremities is appropriate when conservative measures (exercise, leg elevation, weight loss, graduated compression, avoidance of prolonged immobility) have been unsuccessful and symptoms persist.
Excision of a benign skin lesion is covered when there is clinical suspicion of malignancy (e.g., ICD-10-CM D48.5) documented in the medical record.

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J18-L34200, Removal of Benign Skin Lesions

J18

A56914, Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

WPS-J5-L34536, Treatment of Varicose Veins of the Lower Extremities

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