G57.70 — Causalgia of unspecified lower limb
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
- Claims and coding must follow the Local Coverage Determination L37642 that this article complements; medical record documentation should support the billed service in accordance with LCD L37642.
- 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.
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.
- Spinal cord stimulation (SCS) is covered for chronic pain when the clinical record documents the diagnosis and prior conservative therapies tried before the decision to use SCS.
- Temporary SCS trials (CPT 63650) are covered when performed in an office, ambulatory surgical center (ASC), outpatient hospital, or hospital with appropriate clinical documentation.
14 Active Policies
L35098 — Nerve Conduction Studies and Electromyography
J06
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
AETNA-CPB-0552 — Laser Neurolysis
A56607 — Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
A56731 — Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy
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