Does 11643 require prior authorization?

No, 11643 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 11643?

Medicare facility rate: $193.39. Non-facility rate: $315.97. Work RVU: 3.33.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.33

Facility

$193.39

Non-Facility

$315.97

Maintain complete, legible medical records with patient identification on every page and the legible signature of the treating physician or non-physician practitioner.
Medical records must support the selected ICD-10-CM diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
The progress/operative note should document removal of a malignant lesion or an ambiguous but moderate-to-high-suspicion lesion and the record should include the corresponding pathology report.
The size and anatomical location of the lesion must be documented in the operative report.

Excision of malignant or clinically ambiguous lesions with moderate-to-high suspicion that require moderate-to-wide grossly normal skin/soft-tissue margins should be coded using excision of malignant lesion including margins codes 11600-11646.
Excision of benign or low-clinical-suspicion lesions that are removed with minimal surrounding grossly normal skin/soft-tissue margins should be coded using excision of benign lesion codes 11400-11446.
Services are covered only when they meet all indications and limitations in LCD L33818, applicable CMS payment policy manuals, any CMS national coverage determinations, and Medicare payment rules.
Complete surgical excision of a malignant skin lesion, including an appropriate margin of surrounding tissue to eradicate microscopic tumor cells, is the treatment of choice and considered medically necessary.
Excision of a skin lesion including margins is medically necessary when a pathology (histopathology) report verifies the lesion is malignant.

FIRST_COAST-L33818 — Excision of Malignant Skin Lesions

J9 MAC Part B

A57660 — Billing and Coding: Excision of Malignant Skin Lesions

L33818 — Excision of Malignant Skin Lesions

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