Does E11.630 require prior authorization?

No, E11.630 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E11.630` — Type 2 diabetes mellitus with periodontal disease

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.

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.

L35490 — Category III Codes

J05

A58213 — Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

J05

A56232 — Billing and Coding: Foot Care

J05

L38686 — Implantable Continuous Glucose Monitors (I-CGM)

J05

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

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