E10.69 — Type 1 diabetes mellitus with other specified complication
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high 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
L38686 — Implantable Continuous Glucose Monitors (I-CGM)
J05
A56232 — Billing and Coding: Foot Care
J05
L35490 — Category III Codes
J05
A54923 — Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity
J05
A58213
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