L12.35 — Other acquired epidermolysis bullosa
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims missing required NOC narrative information or with incorrect unit reporting will be rejected as unprocessable and may show remark code M123.
- All documentation must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and be produced upon contractor request.
- Medical records must include the legible signature of the physician or non-physician practitioner responsible for the care.
- The submitted medical record must support the ICD-10-CM code(s), the CPT/HCPCS code(s) billed, and the medical necessity of services as stated in the applicable NCD and LCD.
Key Coverage Criteria
- Billing and coding guidance in this article applies when immune globulin use meets the reasonable and necessary coverage criteria established in LCD L35093.
- IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
- Coverage requires documentation that the immune globulin therapy is reasonable and necessary in accordance with LCD L34007 and applicable NCDs.
- IVIG is covered for autoimmune hemolytic anemia (AIHA) when other treatment approaches have failed.
- IVIG is covered for systemic capillary leak syndrome (SCLS).
- IVIG is covered for Guillain–Barré syndrome (GBS) in adults.
6 Active Policies
A57554 — Billing and Coding: Immune Globulins
J05
L34771 — Immune Globulins
J05
A57778 — Billing and Coding: Immune Globulin
J09
L34007 — Immune Globulin
J09
A56786 — Billing and Coding: Immune Globulin
Related Codes
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