Does D04.39 require prior authorization?

No, D04.39 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D04.39` — Carcinoma in situ of skin of other parts of face

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).
Services that meet the Medicare reasonable and necessary requirements per Local Coverage Determination (LCD) L35090 are covered when billed as reconstructive or medically necessary procedures.
Dermabrasion for treatment of rhinophyma is covered when the medical record documents the beneficiary's rhinophyma disease process supporting medical necessity.
Abdominal lipectomy/panniculectomy is covered when the pannus causes chronic intertrigo (skin irritation, infection, or chafing) and there is documented functional impairment (e.g., difficulty walking, exercising, or activities of daily living) after conservative treatment.
Removal of breast implants as reconstructive breast surgery is covered when the medical record describes a condition that makes implant removal medically reasonable and necessary.

L40192 — Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

J05

L34528 — Blepharoplasty, Blepharoptosis and Brow Lift

J05

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

J05

A60212 — Billing and Coding: Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

J05

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