Does R60.9 require prior authorization?

No, R60.9 does not require prior authorization (high confidence). Covered without prior authorization.

`R60.9`, Edema, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The final report must include an impression or summary statement, a specific or differential diagnosis if appropriate, and recommendations for follow-up when clinically applicable.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

Doppler ultrasound (peripheral venous ultrasound) is the standard preoperative test to evaluate venous reflux in patients with chronic venous insufficiency.
CPT 93971 should be used to report either a limited bilateral duplex scan or a complete unilateral duplex scan for peripheral venous reflux evaluation.
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.
Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.

NGS-J6-L33627, Non-Invasive Vascular Studies

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56758, Billing and Coding: Non-Invasive Vascular Studies

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

FIRST_COAST-L33693

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