Does D04.60 require prior authorization?

No, D04.60 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D04.60` — Carcinoma in situ of skin of unspecified upper limb, including shoulder

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This article provides billing and coding guidelines that complement Local Coverage Determination (LCD) L37176 for White Cell Colony Stimulating Factors; refer to LCD L37176 for specific coverage criteria, indications, and limitations.
Maintain the complete medical record and make it available to the contractor upon request; every page must be legible and contain appropriate patient identification (e.g., full name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) used for billing.

Destruction of a skin lesion is covered only when the medical record documents the lesion as malignant by a corresponding pathology report or a clinical description consistent with skin malignancy.
The medical record must include lesion size and lesion location to support medical necessity for destruction of a malignant skin lesion.
Services are covered only when they meet all applicable indications and limitations in LCD L33813, CMS payment policy manuals, any relevant national coverage determinations, and Medicare payment rules.
Excision of malignant or clinically ambiguous lesions with moderate-to-high suspicion that require moderate-to-wide grossly normal skin/soft-tissue margins should be coded using excision of malignant lesion including margins codes 11600-11646.
Excision of benign or low-clinical-suspicion lesions that are removed with minimal surrounding grossly normal skin/soft-tissue margins should be coded using excision of benign lesion codes 11400-11446.
Services are covered only when they meet all indications and limitations in LCD L33818, applicable CMS payment policy manuals, any CMS national coverage determinations, and Medicare payment rules.

L33689 — Mohs Micrographic Surgery (MMS)

J09

A57767 — Billing and Coding: Mohs Micrographic Surgery (MMS)

J09

A57660 — Billing and Coding: Excision of Malignant Skin Lesions

A57788 — Billing and Coding: Peripheral Nerve Blocks

L33933 — Peripheral Nerve Blocks

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