Does D22.4 require prior authorization?

No, D22.4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D22.4` — Melanocytic nevi of scalp and neck

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Maintain all documentation in the patient’s medical record and make it available to the contractor upon request.
Ensure every page of the record is legible and includes appropriate patient identification information, such as complete name and dates of service.
Include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Report histopathologic examination separately when performed using CPT codes 88304-88305.
Select the CPT code for lesion removal by measuring the greatest clinical diameter of the apparent lesion plus the margin required for complete excision, with measurement made prior to excision.
When shave removal is performed solely to obtain a pathologic diagnosis, report tangential (shave) biopsy CPT codes 11102-11103 instead of shave removal codes.
Follow the reasonable and necessary requirements in LCD L34938 for coverage determinations of benign skin lesion removal.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.

A59261 — Billing and Coding: MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma

J05

L39479 — MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma

J05

A57482 — Billing and Coding: Removal of Benign Skin Lesions

J05

L35498 — Removal of Benign Skin Lesions

J05

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