G57.50 — Tarsal tunnel syndrome, unspecified lower limb
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
- Medical records must clearly document medical necessity for each test and include the reason for referral and a clear diagnostic impression.
- Data gathered during NCS should be available showing actual numeric results (latency, amplitude, etc.), preferably in tabular format.
- In cases of review, provide a hard copy of waveforms or a complete written report with interpretation upon request.
Key Coverage Criteria
- No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
- NC-stat testing (CPT 95905) is allowed when the beneficiary has a high pre-test or prior probability of Carpal Tunnel Syndrome (CTS), limited to one service per arm.
- Use CPT 95870 for sampling muscles other than the paraspinals associated with the extremities that have been tested.
- Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
- Peripheral nerve block is reasonable when the patient's pain appears due to a classic mononeuritis but neuro-diagnostic studies fail to provide a structural explanation.
- Peripheral nerve blocks are reasonable for peripheral nerve injuries/entrapment or extremity trauma that lead to complex regional pain syndrome (CRPS).
6 Active Policies
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
L35098 — Nerve Conduction Studies and Electromyography
J06
A56607 — Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
A57788 — Billing and Coding: Peripheral Nerve Blocks
L33933 — Peripheral Nerve Blocks
Related Codes
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