G14, Postpolio syndrome
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A face-to-face encounter and a Written Order Prior to Delivery (WOPD) are required for specified HCPCS codes pursuant to Final Rule 1713 and must be obtained prior to delivery per the LCD-related Standard Documentation Requirements (A55426).
- For reimbursement of replacement A7020, the claim must include the diagnosis code that justifies the need for the interface.
- Suppliers must follow the general documentation requirements in the LCD and the LCD-related Standard Documentation Requirements Article; refer to the related local coverage documents for full policy-specific documentation details.
- Suppliers should contact the PDAC contractor for guidance on correct coding of mechanical in-exsufflation items.
Key Coverage Criteria
- Mechanical in-exsufflation devices are covered under the Durable Medical Equipment (DME) benefit when the beneficiary meets the reasonable and necessary (R&N) requirements specified in the related Local Coverage Determination (LCD).
- Replacement reimbursement for HCPCS A7020 is allowed only if the beneficiary owns or is purchasing the mechanical in-exsufflation device and the claim includes the diagnosis code that justifies medical need.
- CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
- CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
- Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
- CPT 97032 (attended/manual electrical stimulation) is covered when delivered with direct 1-on-1 contact by qualified personnel (examples: direct motor point stimulation; FES/NMES when performed with therapeutic exercise, neuromuscular reeducation, or functional activities).
20 Active Policies
CGS-L35897, Nerve Conduction Studies and Electromyography
J15
A57478, Billing and Coding: Nerve Conduction Studies and Electromyography
J5
A57668, Billing and Coding: Nerve Conduction Studies and Electromyography
J6
WPS-L34594, Nerve Conduction Studies and Electromyography
J8
Related Codes
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