M79.646 — Pain in unspecified finger(s)
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- 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.
- A valid, written, physician-signed and dated plan of treatment must be established prior to provision of physical therapy and must outline type, amount, frequency, duration, functional diagnosis deficits, and anticipated short- and long-term goals.
- Services must be ordered by a physician and the order must be documented in the medical record.
- Treatment notes must be completed per visit, be legible, objectively document findings (e.g., numeric pain scores), relate to established goals, reflect all services billed, and use consistent symbols/acronyms or provide a legend.
Key Coverage Criteria
- Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
- Beneficiary is under the care of a physician.
- Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.
- Beneficiary needs skilled nursing care on an intermittent basis, or physical therapy, or speech-language pathology, or has a continued need for occupational therapy.
- Physical therapy services ordered by a physician and provided by a qualified physical therapist or under the general supervision of a qualified physical therapist are covered when reasonable and necessary to treat illness/injury or to restore or maintain function.
- Physical therapy services provided as a result of a valid written, physician-signed and dated plan of treatment established prior to provision that specifies type, amount, frequency, duration, functional diagnosis deficits, and short- and long-term goals are covered.
20 Active Policies
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A57589 — Billing and Coding: Nerve Blocks for Peripheral Neuropathy
J05
L35222 — Nerve Blocks for Peripheral Neuropathy
J05
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
Related Codes
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