B47.9 — Mycetoma, unspecified
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."
- Avian influenza A virus (H5N1): documentation of symptoms consistent with Avian influenza A virus and history of travel to or contact with persons or birds from a country with documented H5N1 avian influenza infections within 10 days of symptom onset.
- Cerebrospinal fluid (CSF) pathogen panel: Member has clinical findings consistent with a central nervous system (CNS) infection (e.g., meningitis, encephalitis); and viral etiology is suspected or the CSF culture is inconclusive for pathogen etiology (i.e., viral, bacterial, fungal).
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-0383 — Mohs Micrographic Surgery
AETNA-CPB-0650 — Polymerase Chain Reaction Testing: Selected Indications
ANTHEM-CG-SURG-24 — CG-SURG-24 Functional Endoscopic Sinus Surgery (FESS)
Related Codes
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