Does D81.818 require prior authorization?

No, D81.818 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D81.818` — Other biotin-dependent carboxylase deficiency

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When routine foot care needs to meet one of the exclusions, include the applicable Q modifier on the claim: Q7 for 1 Class A finding, Q8 for 2 Class B findings, and Q9 for 1 Class B plus 2 Class C findings.
For all foot-care claims report an appropriate foot/toe location modifier (e.g., LT, RT, TA, T1-T9) to identify laterality and specific toe when applicable.
If a significant, separately identifiable evaluation and management service is provided on the same day as routine foot care, append modifier -25 to the E/M claim line.
Total the number of keratotic lesions debrided and select the most appropriate CPT code 11055-11057 based on that total (example: code 11056 for two to four lesions).

Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
Treatment of warts (including plantar warts) on the foot is covered to the same extent as wart treatment at other anatomic sites.
Foot care services that are a necessary and integral part of otherwise covered services (e.g., diagnosis or treatment of diabetic ulcers, wounds, or infections) are covered.
Routine foot care otherwise excluded may be covered when systemic conditions (metabolic, neurologic, or peripheral vascular disease) cause severe circulatory compromise or areas of diminished sensation and supporting Class A/B/C findings are documented.

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

A58963 — Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

J06

A57759 — Billing and Coding: Routine Foot Care and Debridement of Nails

J06

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