Does 57061 require prior authorization?

No, 57061 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 57061?

Medicare facility rate: $105.55. Non-facility rate: $163.00. Work RVU: 1.27.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.27

Facility

$105.55

Non-Facility

$163.00

Documentation of infection when applicable (e.g., diagnosis of warts, molluscum contagiosum).
Documentation that the lesion restricts vision or obstructs a body orifice, if that is the basis for removal.
Clinical description consistent with suspicion for malignancy using ABCDE features (asymmetry, border, color, diameter >6 mm, evolving) where removal is for concern of malignancy.
Biopsy/pathology report when biopsy has been performed showing premalignancy or malignancy (this is an explicit selection criterion).

Removal of acquired nevi (moles) when any of the selection criteria below are met.
Removal of small congenital nevi (less than 1.5 cm) when any of the selection criteria below are met.
Removal of cutaneous and subcutaneous neurofibromas when any of the selection criteria below are met.
Removal of dermatofibromas when any of the selection criteria below are met.
Removal of dermatosis papulosa nigra when any of the selection criteria below are met.
Removal of acrochordon (skin tags) when any of the selection criteria below are met.

AETNA-CPB-0633 — Benign Skin Lesion Removal

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