Does C63.2 require prior authorization?

No, C63.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C63.2` — Malignant neoplasm of scrotum

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

A CLIA certification number must be reported on all Mohs claims (item 23 on the CMS-1500 form or electronic equivalent).
The medical record must clearly document and support the circumstances when modifier -59 is used to distinguish a diagnostic biopsy from definitive Mohs surgery.
When appropriate to report modifier -59, report the modifier on the same line as the biopsy procedure codes and do not report -59 on the same line as the Mohs procedure.
Report the appropriate Mohs surgery code with quantities for the specimens mapped in the days/units field (units must reflect number of stages/blocks as applicable).

Bill CPT 17311-17315 for Mohs micrographic surgery when the surgeon removes the lesion and performs the intraoperative pathologic examination (surgeon prepares and interprets slides).
If the specimen(s) from the Mohs procedure are submitted to another physician (pathologist) who performs the frozen or permanent section examination, report the pathology by the performing pathologist (the service is not considered Mohs when the pathologist performs the exam).
Coverage is allowed for targeted genomic sequence analysis panels for treatment of solid organ neoplasms when the panel is a DNA analysis panel containing at least 5 gene tests for molecular biomarkers that meet Medicare coverage criteria.
Coverage is allowed when the genomic testing is expected to influence the treatment of the condition (i.e., documentation supports that test results will affect clinical management of the solid organ neoplasm).
Genomic testing of acquired conditions such as malignancies, including separate malignancies developing at different times, is permitted when medically reasonable and necessary to assess response or other clinically relevant criteria.
CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.

L38158 — MolDX: Next-Generation Sequencing for Solid Tumors

J05

A57936 — Billing and Coding: MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J05

L35494 — Mohs Micrographic Surgery

J05

L38835 — MolDX: Minimal Residual Disease Testing for Cancer

J05

A58468

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