M14.671 — Charcot's joint, right ankle and foot
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Specified HCPCS codes require a face-to-face encounter and Written Order Prior to Delivery (WOPD) per Final Rule 1713; failure to obtain WOPD prior to delivery results in denial.
- Supplier must include diagnosis code(s) on the claim line for HCPCS L4396, L4397, L4392 and L4631.
- For custom-fabricated orthoses, the supplier's records must document medical necessity for a custom device rather than a prefabricated orthosis and be available upon request.
- Supplier records must show the product specified by the treating practitioner, the treating practitioner's medical record that justifies the type of product (prefabricated versus custom), and detailed justification for the HCPCS code billed.
Key Coverage Criteria
- Ankle-foot orthoses (AFO) and knee-ankle-foot orthoses (KAFO) are covered when they are rigid or semi-rigid devices used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body.
- Coverage requires that reasonable and necessary (R&N) medical necessity criteria in the related Local Coverage Determination (LCD) are met for the beneficiary's diagnosis or functional deficit.
- An orthosis provided within two days prior to discharge to home is eligible for DME MAC coverage if it is medically necessary after discharge and was not needed for inpatient treatment or rehabilitation.
- 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).
- CPT 97032 may be billed for the application, instruction, and adjustment of a TENS unit or other probe-based stimulation (including determining trigger points) when provided as an attended/manual modality.
- Non-implantable pelvic floor electrical stimulation (97032 for probes; G0283 for electrode-based delivery) is covered for treatment of stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
20 Active Policies
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A58893 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J06
L39139 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J06
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