Does S94.90XD require prior authorization?

No, S94.90XD does not require prior authorization (high confidence). Covered without prior authorization.

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`S94.90XD`, Injury of unspecified nerve at ankle and foot level, unspecified leg, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
All documentation must be maintained in the medical record, be legible, include patient identification (e.g., full name, dates of service), and include the legible signature of the treating physician or non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code must accurately describe the service performed.

For podiatrist-submitted claims with ICD-10 codes marked with an asterisk, the claim must include the name of the M.D., D.O., or non-physician practitioner who diagnosed the complicating condition and the approximate date the beneficiary was last seen by that provider.

Key Coverage Criteria

No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
Routine foot care is covered only when the patient has one or more diagnoses listed in the LCD L33941 “ICD-10 Codes that Support Medical Necessity.”
Patients with peripheral neuropathy involving the feet (without vascular impairment) are covered when billed with the Group 3 ICD-10 codes appropriate for peripheral neuropathy.
Patients requiring anticoagulation therapy are covered when billed with the Group 4 ICD-10 codes documenting anticoagulation-related risk.
Patients with Group 2 (complicating) diagnoses may be covered when the claim includes the appropriate Q modifier (Q7, Q8, or Q9) and the medical record documents the required Class A, B, and/or C findings per the definitions.
Routine foot care may be covered for patients with peripheral neuropathy of the feet without vascular impairment when the neuropathy is severe enough that care by a non‑professional would place the patient at risk.

3 Active Policies

FIRST_COAST-L33941, Routine Foot Care

A56607, Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

A57188, Billing and Coding: Routine Foot Care

`S94.90XD`, Injury of unspecified nerve at ankle and foot level, unspecified leg, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

S94.90XD, Injury of unspecified nerve at ankle and foot level, unspecified leg, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`S94.90XD`, Injury of unspecified nerve at ankle and foot level, unspecified leg, subsequent encounter