ICD-10-CM S92.811A, Other fracture of right foot, initial encounter for closed fracture | No Prior Auth

ICD-10-CM S92.811A, Other fracture of right foot, initial encounter for closed fracture | No Prior Auth

Key Coverage Criteria

Duplex scan of lower extremity arteries is covered when medically necessary per LCD L33667, with the ordering/referring provider documenting signs and symptoms, relevant history (including known diagnoses and/or prior imaging) supporting evaluation of lower extremity arterial disease.
Medicare allows ultrasonic osteogenesis stimulators only if all of the following criteria are met: nonunion of a fracture documented by a minimum of two sets of radiographs obtained prior to starting treatment with the osteogenic stimulator, separated by a minimum of 90 days; and the fracture is not of the skull or vertebrae; and the fracture is not tumor related.
Covered CPT/HCPCS codes for electrical stimulation if selection criteria are met: CPT 20974 (electrical stimulation noninvasive), CPT 20975 (invasive operative); HCPCS E0747 (electrical, noninvasive, non-spinal applications), E0748 (electrical, noninvasive, spinal applications), E0749 (electrical, surgically implanted).
Examples of covered diagnoses (ICD-10 codes listed as covered if selection criteria are met) include spondylolisthesis (M43.10-M43.19), malunion of fracture, nonunion of fracture, congenital pseudarthrosis/other congenital malformations of limbs (Q74.0-Q74.9), congenital spondylolisthesis (Q76.2), Colles fracture (S52.531+ - S52.539+), scaphoid fracture (S62.001+ - S62.036+), fractures of tibia (S82.101+ - S82.299+), medial malleolus, fibula fractures, pilon fracture of tibia, Jones (5th metatar [...]
Electrical stimulation for spine fusion when any of the following indications are met: failed spinal fusion where a minimum of nine months has elapsed since the last surgery; or following a multilevel spinal fusion surgery; or following spinal fusion surgery where there is a history of a previously failed spinal fusion at the same site (Medicare note: a multilevel spinal fusion is one which involves 3 or more vertebrae).
Non-spinal electrical stimulation (Medicare-supported indications): nonunion of a long bone fracture, defined as radiographic evidence that fracture healing has ceased for three or more months prior to starting treatment with the osteogenesis stimulator; or failed fusion of a joint other than in the spine where a minimum of nine months has elapsed since the last surgery; or congenital pseudarthrosis.