S96.019A — Strain of muscle and tendon of long flexor muscle of toe at ankle and foot level, unspecified foot, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- "Medically necessary" or "medical necessity" definition must be met and documented: clinical rationale consistent with generally accepted standards of medical practice, clinically appropriate in terms of type, frequency, extent, site, and duration, effective for the patient's illness/injury/ disease, not primarily for convenience, and not more costly than an alternative service.
- The patient's medical records should document the practitioner's clinical rationale for performing the specific strapping or taping procedures, as well as the patient's response.
- Any time taping is done, the health care record must clearly document the specific reasons for, and location of, the taping.
- If the service that includes the taping is billed to a payor, the taping must be consistent with the documented chief complaint / clinical examination findings, diagnosis and treatment plan.
Key Coverage Criteria
- Strapping is considered medically necessary for the management of immobilization of a joint and restriction of movement with strapping tape (i.e., rigid, non-elastic or non-stretchy tape) for ANY of the following indications:
- Strapping of hand or finger (CPT code 29280) for: fracture of finger
- Strapping of hand or finger (CPT code 29280) for: dislocation of finger
- Strapping/taping of ankle or foot (CPT code 29540) for: acute sprains and strains of ankle and foot
- Strapping/taping of ankle or foot (CPT code 29540) for: dislocations of ankle and foot
- Strapping/taping of ankle or foot (CPT code 29540) for: fractures of ankle and foot
1 Active Policy
CIGNA-CPG143 — Strapping and Taping - (CPG143)
Related Codes
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