Does D23.111 require prior authorization?

No, D23.111 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D23.111` — Other benign neoplasm of skin of right upper eyelid, including canthus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This policy provides billing, coding, and guideline information that complements the Local Coverage Determination (LCD) 'Cosmetic and Reconstructive Surgery' L33428; the full policy content is not included here, so specific documentation requirements (e.g., medical records, prior authorizations, forms) are not available in the provided excerpt.
Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.
Physician documentation must state that the biopsy was performed on a lesion other than the lesion on which MMS was performed.
If the biopsy is of the same lesion, physician documentation must state that a biopsy of that lesion had not been done within the previous 60 days.

No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
Modifier 59 is appropriate to allow separate payment for a skin biopsy and associated pathology on the same day as Mohs Micrographic Surgery (MMS) when the biopsy is performed on a lesion other than the lesion for which MMS is performed.
Modifier 59 is appropriate when the biopsy is of the same lesion as the MMS lesion only if no biopsy of that lesion was performed within the previous 60 days.
Modifier 59 may be appropriate when a recent (within 60 days) biopsy of the same lesion exists but the biopsy results were unobtainable by the Mohs surgeon after reasonable effort.
Laboratory tests associated with MMS may be billed only if the billing facility holds a valid CLIA certificate of registration (type 9), certificate of compliance (type 1), or certificate of accreditation (type 3).
Blepharoplasty, blepharoptosis repair, or brow lift is covered when documented signs or symptoms of a functional abnormality of the upper eyelids are present as defined by the associated LCD (L34528).

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

J05

L34528 — Blepharoplasty, Blepharoptosis and Brow Lift

J05

L35498 — Removal of Benign Skin Lesions

J05

A57482 — Billing and Coding: Removal of Benign Skin Lesions

J05

A57452

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