Does A63.0 require prior authorization?

No, A63.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`A63.0` — Anogenital (venereal) warts

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
Maintain all documentation in the patient’s medical record and make it available to the contractor upon request.
Ensure every page of the record is legible and includes appropriate patient identification information, such as complete name and dates of service.

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
Report histopathologic examination separately when performed using CPT codes 88304-88305.
Select the CPT code for lesion removal by measuring the greatest clinical diameter of the apparent lesion plus the margin required for complete excision, with measurement made prior to excision.
When shave removal is performed solely to obtain a pathologic diagnosis, report tangential (shave) biopsy CPT codes 11102-11103 instead of shave removal codes.
Follow the reasonable and necessary requirements in LCD L34938 for coverage determinations of benign skin lesion removal.

L37205 — Chemotherapy Drugs and their Adjuncts

J05

A55639 — Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions

J05

A57482 — Billing and Coding: Removal of Benign Skin Lesions

J05

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

Ask Verity about documentation requirements, denial risks, or coverage in your state.