B36.0 — Pityriasis versicolor
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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."
- For Barrett's esophagus carcinoma in-situ: documentation that member is not a candidate for esophagectomy (policy language: "Barrett's esophagus carcinoma in-situ and high-grade disease in members who are not candidates for esophagectomy").
- For microinvasive endobronchial non-small cell lung cancer: documentation that surgery and radiotherapy are not indicated (policy language: "Microinvasive endobronchial non-small cell lung cancer at an early stage, for whom surgery and radiotherapy are not indicated").
Key Coverage Criteria
- Recurrent or incompletely excised malignant lesions, regardless of anatomic region
- Aetna considers surgery with the Mohs technique medically necessary for any of the following skin conditions:
- Areas of important tissue preservation (ears, face, feet, hands, genitalia, and perianal)
- Atypical fibroxanthoma
- Dermatofibrosarcoma protuberans
- For exceptionally large (2 cm or larger in diameter) or rapidly growing lesions in any anatomic region
3 Active Policies
AETNA-CPB-0375 — Photodynamic Therapy
AETNA-CPB-0383 — Mohs Micrographic Surgery
ANTHEM-CG-MED-73 — CG-MED-73 Hyperbaric Oxygen Therapy (Systemic/Topical)
Related Codes
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