L00 — Staphylococcal scalded skin syndrome
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No specific documentation requirements, prior authorization, or required medical records/test results are specified in this policy bulletin.
- Note: External guidance cited (NICE 2007) recommends use only in research settings (controlled trials, closely observed case series and/or contribution to a register), which would imply research documentation if used in that context, but Aetna's CPB itself does not list documentation requirements.
Key Coverage Criteria
- None — Aetna considers Grenz ray therapy experimental and investigational for the treatment of dermatologic conditions because there is inadequate evidence in the published peer-reviewed medical literature regarding the effectiveness of Grenz ray therapy in the treatment of skin disorders.
1 Active Policy
AETNA-CPB-0231 — Grenz Ray Therapy for Skin Disorders
Related Codes
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