Does D03.111 require prior authorization?

No, D03.111 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D03.111` — Melanoma in situ of right upper eyelid, including canthus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When reporting the JW modifier for discarded drug, the medical record must clearly show the amount administered and the amount wasted.
Medical record must document prior anthracycline therapy for patients receiving albumin-bound paclitaxel, or clearly document a clinical contraindication to anthracycline therapy.
For claims with no discarded amounts from single-dose containers or single-use packages, include the JZ modifier as evidence on the claim (effective July 1, 2023).
Document dose and frequency as consistent with the FDA label or recognized compendia for the indication (including citations to the compendia if used for off-label indications).

Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling.
Off-label uses of paclitaxel are covered when supported by recognized compendia (e.g., NCCN, AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex) and dosing/frequency follow those compendia.
Albumin-bound paclitaxel (Abraxane) is covered when prior therapy included an anthracycline unless anthracycline therapy is clinically contraindicated.
Oncomine DX Test (CPT 0022U) is covered when billed with CPT 0022U and the claim narrative contains the identifier 'Oncomine DX'.
Rosetta Cancer Origin Test (CPT 81479) is covered when conventional surgical pathology and/or imaging work-up is unable to identify a primary neoplastic site and an 'Initial Work-Up …' comment is submitted on the claim.
VeriStrat assay (CPT 81538) is covered when a preliminary predictive testing evaluation has been performed prior to ordering and an 'Initial Work-Up …' comment is submitted on the claim.

A57477 — Billing and Coding: Mohs Micrographic Surgery

J05

A55161 — Billing and Coding: MolDX: FDA-Approved BRAF Tests

J05

L35494 — Mohs Micrographic Surgery

J05

A56908 — Billing and Coding: Blepharoplasty, Blepharoptosis and Brow Lift

J05

L36807

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