Does E0671 require prior authorization?

No, E0671 does not require prior authorization (low confidence). No active coverage policies found for this code.

`E0671`, Segmental gradient pressure pneumatic appliance, full leg

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

For repeat trigeminal neuralgia cryoanalgesia: documentation supporting prior benefit and that repeat procedure is at least 6 months after prior cryoanalgesia.
For passive cold compression therapy as DME: clinical documentation supporting the need to control swelling, edema, hematoma, hemarthrosis and pain (i.e., reason for DME), and appropriate physician order for DME.
When CPT/HCPCS coding is used, documentation must support that the procedure/code corresponds to an indication covered by this CPB (i.e., link diagnosis, procedure note, operative report or DME order to the covered indication).
Any use of cryoanalgesia/cryoneurolysis for indications that the CPB lists as experimental/investigational should be supported by documentation if submitted, but the CPB considers these not medically necessary (i.e., documentation will not make them covered).
For cryoanalgesia for chronic refractory trigeminal neuralgia: documentation that member has experienced pain for at least 6 months.
For trigeminal neuralgia cryoanalgesia: documentation that the member has tried and failed pharmacotherapies (examples listed: baclofen, carbamazepine, phenytoin) or is unable to tolerate medication side effects.

Pneumatic compression devices are medically necessary for the treatment of lymphedema or chronic venous insufficiency (CVI) with edema and non-healing lower extremity ulcers.
ICD-10 G50.0: Trigeminal neuralgia (covered if selection criteria are met)
Use of CPT codes 64600 (destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64620 (destruction by neurolytic agent, intercostal nerve) when furnished for the indications listed in this CPB.
Selected ICD-10 diagnoses may be covered when selection criteria are met (examples listed in the CPB include G50.0 Trigeminal neuralgia; various joint effusion/hemarthrosis/pain codes; edema and swelling codes; pain codes), noting coverage is diagnosis- and criteria-dependent.
Cryoanalgesia for the temporary relief of pain due to chronic refractory trigeminal neuralgia (subject to Appendix selection criteria).
Pre-operative, intra-operative, and post-operative cryoanalgesia for post-operative pain management related to the Nuss procedure (pectus excavatum repair).

ANTHEM-CG-DME-46, CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting

ANTHEM-CG-DME-06, CG-DME-06 Compression Devices for Lymphedema

UHC-POL-pneumatic-compression-devices, Pneumatic Compression Devices

AETNA-CPB-0297, Cryoanalgesia and Therapeutic Cold

AETNA-CPB-0069, Lymphedema

CIGNA-0354, Compression Devices

BCBSIL-MED202.060, Compression Pumps for Treatment of Lymphedema and Venous Ulcers

BCBSIL-MED202.073, Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis

BCBSMT-MED202.060, Compression Pumps for Treatment of Lymphedema and Venous Ulcers

BCBSMT-MED202.073, Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis

BCBSNM-MED202.060, Compression Pumps for Treatment of Lymphedema and Venous Ulcers

BCBSNM-MED202.073, Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis

BCBSOK-MED202.060, Compression Pumps for Treatment of Lymphedema and Venous Ulcers

BCBSOK-MED202.073, Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis

REGENCE-DME90, Postsurgical Home Use of Limb Compression Devices

UMR-POL-UMR-pneumatic-compression-devices, Pneumatic Compression Devices

SUREST-POL-SUREST-pneumatic-compression-devices, Pneumatic Compression Devices

Ask Verity about documentation requirements, denial risks, or coverage in your state.

E0671, Segmental gradient pressure pneumatic appliance, full leg

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

For repeat trigeminal neuralgia cryoanalgesia: documentation supporting prior benefit and that repeat procedure is at least 6 months after prior cryoanalgesia.
For passive cold compression therapy as DME: clinical documentation supporting the need to control swelling, edema, hematoma, hemarthrosis and pain (i.e., reason for DME), and appropriate physician order for DME.
When CPT/HCPCS coding is used, documentation must support that the procedure/code corresponds to an indication covered by this CPB (i.e., link diagnosis, procedure note, operative report or DME order to the covered indication).
Any use of cryoanalgesia/cryoneurolysis for indications that the CPB lists as experimental/investigational should be supported by documentation if submitted, but the CPB considers these not medically necessary (i.e., documentation will not make them covered).
For cryoanalgesia for chronic refractory trigeminal neuralgia: documentation that member has experienced pain for at least 6 months.
For trigeminal neuralgia cryoanalgesia: documentation that the member has tried and failed pharmacotherapies (examples listed: baclofen, carbamazepine, phenytoin) or is unable to tolerate medication side effects.

Pneumatic compression devices are medically necessary for the treatment of lymphedema or chronic venous insufficiency (CVI) with edema and non-healing lower extremity ulcers.
ICD-10 G50.0: Trigeminal neuralgia (covered if selection criteria are met)
Use of CPT codes 64600 (destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64620 (destruction by neurolytic agent, intercostal nerve) when furnished for the indications listed in this CPB.
Selected ICD-10 diagnoses may be covered when selection criteria are met (examples listed in the CPB include G50.0 Trigeminal neuralgia; various joint effusion/hemarthrosis/pain codes; edema and swelling codes; pain codes), noting coverage is diagnosis- and criteria-dependent.
Cryoanalgesia for the temporary relief of pain due to chronic refractory trigeminal neuralgia (subject to Appendix selection criteria).
Pre-operative, intra-operative, and post-operative cryoanalgesia for post-operative pain management related to the Nuss procedure (pectus excavatum repair).