Does Z74.01 require prior authorization?

No, Z74.01 does not require prior authorization (high confidence). Covered without prior authorization.

`Z74.01`, Bed confinement status

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Inferred documentation items (from the text and cited trials/guidelines) that would support medical necessity: documentation of the clinical indication (e.g., trauma, recent orthopedic surgery, neurosurgery, acute ischemic stroke with restricted mobility, documented immobility such as inability to walk to the toilet without help),
For CLI: documentation that the patient has severe or critical limb ischemia and is not a candidate for surgical revascularization (text: "non-revascularization-based therapies used to treat patients with severe or critical limb ischemia (CLI) who are not candidates for surgical revascularization").
For lymphedema: documentation that intermittent pneumatic compression is being used as an adjunct to complex decongestive therapy (CDT), particularly where mobility or exercise is compromised.

In patients with acute ischemic stroke and restricted mobility, the guideline authors suggested the use of prophylactic-dose heparin or IPC devices (Grade 2B).
CLOTS 3 trial finding: IPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke.
IPC devices have been used for thrombosis prophylaxis after total hip replacement (THR) and total knee arthroplasty (TKA) (various devices and configurations described).
Intermittent pneumatic compression has been used as a modality to aid fracture and soft-tissue healing and as adjunct in rehabilitation (small/suggestive studies).
Intermittent pneumatic compression has been used to treat or aid healing of venous leg ulcers and venous insufficiency (evidence mixed/limited).
IPC has been used as adjunctive therapy for critical limb ischemia (CLI) in patients who are not candidates for surgical revascularization (studies suggest possible limb-salvage benefit but evidence low quality).

AETNA-CPB-0430, Pressure Reducing Support Surfaces

AETNA-CPB-0500, Intermittent Pneumatic Compression Devices

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