G90.513 — Complex regional pain syndrome I of upper limb, bilateral
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
- When billing a Z-code as the diagnosis, documentation must include the orthotic/prosthetic device name, date patient received the device, and date training/teaching began.
- Documentation for CPT 97542 wheelchair propulsion training must relate the training to expected, attainable functional goals for the patient and/or caregiver.
- Physical therapists must report patient contact time in 15-minute increments and bill using G0151 for physical therapy time reporting.
Key Coverage Criteria
- 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.
- Autonomic function tests are covered when they meet the reasonable and necessary requirements of Local Coverage Determination (LCD) L35395.
- Cardiovagal innervation testing should be reported when performed using CPT code 95921.
- Vasomotor adrenergic innervation testing should be reported when performed using CPT code 95922.
20 Active Policies
L34616 — Psychiatry and Psychology Services
J05
A57551 — Billing and Coding: Autonomic Function Testing
J05
A57480 — Billing and Coding: Psychiatry and Psychology Services
J05
L34594 — Nerve Conduction Studies and Electromyography
J05
L35124
Related Codes
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