Does S86.199S require prior authorization?

No, S86.199S does not require prior authorization (high confidence). Covered without prior authorization.

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`S86.199S`, Other injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, unspecified leg, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For ICD-10-CM codes designated with an asterisk, the patient must be under the active care of a MD/DO who documents the condition and the claim must include the attending physician's name and NPI in CMS-1500 blocks 17/17B, the date patient was last seen (DPLS) in block 19, and the complicating systemic disease in block 21.
All claims for routine foot care based on a systemic condition must include a billing indicator modifier Q7, Q8, or Q9 as appropriate to be considered for payment.
Mycotic nail services should be coded with ICD-10-CM B35.1 as primary and one of the listed secondary diagnosis codes (L02.611, L02.612, L03.031, L03.032, L03.041, L03.042, M79.671, M79.672, M79.674, M79.675, R26.2); systemic condition modifiers are not required for these mycotic nail–based services.

When the patient’s condition is one of the asterisk‑designated diagnoses, routine procedures are covered only if the patient is under the active care of a MD/DO who documents the condition (active care documentation required).

This document (background/review section) does not specify documentation requirements, prior authorization criteria, frequency limits, ICD-10 or CPT codes, or other medical-record requirements for phonophoresis.

No explicit 'Documentation Requirements' section is present in this text chunk.

Key Coverage Criteria

Nail debridement (CPT 11720 or 11721) for mycotic nails is covered when billed with ICD-10-CM B35.1 as the primary diagnosis and one of the following as a secondary diagnosis: L02.611, L02.612, L03.031, L03.032, L03.041, L03.042, M79.671, M79.672, M79.674, M79.675, or R26.2.
Routine foot care services are covered when the patient has one of the specified systemic conditions (e.g., diabetes mellitus; arteriosclerosis obliterans; Buerger's disease; chronic thrombophlebitis; peripheral neuropathies of the feet including those associated with malnutrition, alcoholism, malabsorption, pernicious anemia, carcinoma, drugs/toxins, multiple sclerosis, uremia, traumatic injury, leprosy/neurosyphilis, hereditary disorders including hereditary sensory radicular neuropathy, Fabry [...]
A presumption of coverage for routine foot care exists when the physician rendering the service documents and bills using modifier Q7 (one Class A finding), Q8 (two Class B findings), or Q9 (one Class B plus two Class C findings) and a systemic condition diagnosis from the listed conditions is present.

2 Active Policies

AETNA-CPB-0210, Phonophoresis

A56680, Billing and Coding: Routine Foot Care

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S86.199S, Other injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, unspecified leg, sequela