B35.0 — Tinea barbae and tinea capitis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The CPB does not state specific, detailed documentation requirements; it indicates that CPT/ICD-10 codes are covered "if selection criteria are met." No explicit required medical record elements, prior-authorization items, or exact documentation checklists are provided in this document.
- No explicit "Documentation Requirements" section is provided in this Clinical Policy Bulletin.
- Billing limitation/note that may affect documentation: "Mohs micrographic surgery requires a single physician to act in 2 integrated, but separate and distinct capacities: surgeon and pathologist. If either of these responsibilities is delegated to another physician who reports his/her services separately, the use of the Mohs micrographic surgery CPT codes is inappropriate."
Key Coverage Criteria
- Medicinal leech therapy is medically necessary for salvage of vascularly compromised flaps (muscle, skin, and fat tissue surgically removed from one part of body to another).
- Medicinal leech (Hirudo medicinalis) therapy is medically necessary for any of the following conditions: poor venous drainage (venous congestion/venous outflow obstruction).
- Medicinal leech therapy is medically necessary for salvage of vascularly compromised replants (limbs or other body parts re-attached after traumatic amputation).
- Medical maggots (larval therapy) are medically necessary for debridement of non-healing necrotic skin and soft tissue wounds including chronic diabetic foot ulcers.
- Medical maggots are medically necessary for debridement of neuropathic foot ulcers.
- Medical maggots are medically necessary for debridement of non-healing traumatic or post-surgical wounds.
3 Active Policies
AETNA-CPB-0383 — Mohs Micrographic Surgery
AETNA-CPB-0556 — Bio-Surgery: Medicinal Leech Therapy and Medical Maggots
ANTHEM-CG-LAB-20 — CG-LAB-20 Thyroid Testing
Related Codes
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