Does D04.9 require prior authorization?

No, D04.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D04.9` — Carcinoma in situ of skin, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When billing J7999-KD, enter the name and total dose (mg or mcg) of each drug in Box 19 of the CMS-1500 or the appropriate electronic comment loop; if Box 19 cannot accommodate all information, attach the details to the paper claim.
If a portion of a single-dose vial is not used, submit the HCPCS code for the drug on a separate claim line and append modifier JW to indicate discarded/unused portion.
Separate payment may be made for pump refilling and/or adjustments; submit these services using the appropriate drug refill or maintenance CPT/HCPCS code that accurately describes the service rendered.
Compounded drugs are priced by the A/B MAC contractor by multiplying the contractor's price per mcg or mg by the total number of mcg or mg of each drug used; a pharmacy compounding fee may be allowed in addition to the calculated drug amount.

Compounded medications for use in implantable infusion pumps may be covered by Medicare when their use meets all other criteria for services provided incident to a physician's service.
True off-the-shelf (non‑compounded) drugs used without compounding and administered via DME may be billed using the drug-specific HCPCS code and are reimbursed under CMS ASP methodology.
If Prialt® is implanted as a single agent in the pump, bill using HCPCS code J2278-KD.
Compounded single-agent or combination drug formulations used in implanted infusion pumps must be billed using HCPCS code J7999-KD for reimbursement.
Removal of benign skin lesions billed with CPT 17106, 17107, or 17108 is covered only when clinical records document medical necessity and explicitly state why the procedure is not cosmetic.
Treatment of hyperkeratotic lesions (e.g., corns and calluses) billed with CPT 11055, 11056, or 11057 is covered as described in the Medicare Internet-Only Manual.

CIGNA-CPG030 — Low-Level Laser and High-Power Laser Therapy - (CPG030)

A57162 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

AETNA-CPB-0383 — Mohs Micrographic Surgery

AETNA-CPB-0633 — Benign Skin Lesion Removal

ANTHEM-MP-A050278 — Last Review Date

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