Does S86.802A require prior authorization?

No, S86.802A does not require prior authorization (high confidence). Covered without prior authorization.

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`S86.802A`, Unspecified injury of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter

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.
CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
Foot care services are covered when the beneficiary has a listed systemic condition that justifies coverage per Medicare Benefit Policy Manual Pub.100-02, Ch.15, Section 290.4D.
For diagnosis codes designated by an asterisk, the patient must be under the active care of an M.D. or D.O., documented as having been seen for the complicating disease within the 6 months prior to service.

6 Active Policies

A56232, Billing and Coding: Foot Care

NOVITAS-JH-L35138, Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

A53058, Billing and Coding: Home Health Physical Therapy

A56680, Billing and Coding: Routine Foot Care

`S86.802A`, Unspecified injury of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

S86.802A, Unspecified injury of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`S86.802A`, Unspecified injury of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter