Does E09.40 require prior authorization?

No, E09.40 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`E09.40` — Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

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

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier prior to claim submission.
Certifying physician must document in the medical record one or more qualifying foot conditions during an in-person visit within 6 months prior to delivery and prior to or on the same day as signing the certification statement, or must obtain/initial/date and agree with documentation from an in-person visit by qualifying clinicians within 6 months prior to delivery.
Certifying physician must sign the certification statement on or after the in-person visit and within 3 months prior to delivery of the shoes/inserts.
If an NP or PA provides ancillary services 'incident to', the supervising physician must document that the patient is diabetic and receiving ongoing follow-up, the NP/PA must certify the provision is part of the comprehensive treatment plan, and the supervising physician must review, sign, and date the NP/PA notes related to the therapeutic shoes.

Key Coverage Criteria

Beneficiary has diabetes mellitus documented in the medical record.
Documented previous amputation of the other foot or part of either foot.
Documented history of previous foot ulceration of either foot.
Documented history of pre-ulcerative calluses of either foot.
Peripheral neuropathy with evidence of callus formation of either foot documented in the medical record.
Documented foot deformity of either foot.

20 Active Policies

L35490 — Category III Codes

J05

A57589 — Billing and Coding: Nerve Blocks for Peripheral Neuropathy

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

L38686 — Implantable Continuous Glucose Monitors (I-CGM)

J05

A58213

Have a follow-up question?

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

Supplier must conduct and document an in-person evaluation prior to selecting items and must document an objective fit assessment at delivery (subjective beneficiary statements alone are insufficient).

For specified HCPCS codes subject to Final Rule 1713, a face-to-face encounter and Written Order Prior to Delivery (WOPD) are required as specified in LCD-related Standard Documentation Requirements Article (A55426).

— Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

A56232 — Billing and Coding: Foot Care

J05

L35222 — Nerve Blocks for Peripheral Neuropathy

J05

L35098 — Nerve Conduction Studies and Electromyography

J06

L38623 — Implantable Continuous Glucose Monitors (I-CGM)

J06

A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography

J06

A58116 — Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

J06

A58136 — Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

J09

L38664 — Implantable Continuous Glucose Monitors (I-CGM)

J09

L35138 — Routine Foot Care

J12

L38617 — Implantable Continuous Glucose Monitors (I-CGM)

J12

A58110 — Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

J12

A52996 — Billing and Coding: Routine Foot Care

J12

A52507 — External Infusion Pumps - Policy Article

J19

A52501 — Therapeutic Shoes for Persons with Diabetes - Policy Article

J19

E09.40 — Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified