Does L45 require prior authorization?

No, L45 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L45`, Papulosquamous disorders in diseases classified elsewhere

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical record must include relevant history, physical exam, and signs/symptoms that required the I&D procedure; diagnostic test results or the symptoms prompting tests must be recorded.
Pre-operative documentation must record size, location and appearance of the abscess/collection; the operative note must describe the procedure, equipment used, and approximate quantity (e.g., 1 cc, 5 ml) and quality (e.g., serous, bloody, frank pus) of material drained.
If multiple or repeated I&Ds are performed for the same anatomic area, records must explain reasons for recurrence and measures taken to prevent recurrence; photographic or operative documentation may be requested for patterns suggestive of abuse.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Providers billing I&D for pus-producing paronychia of the foot (without ingrown toenail) must have medical record documentation available to Medicare upon request to support use of I&D rather than nail procedures.
Maintain all documentation in the patient’s medical record and make it available to the contractor upon request.

Incision and drainage (I&D) is covered when medical record documents an abscess, hematoma, seroma or other collection of the skin/subcutaneous/accessory structures requiring drainage with signs/symptoms that justify the procedure (e.g., evidence of infection, frank pus, severe pain, or failure of conservative measures).
For podiatry (specialty 48), CPT codes 10060, 10061 or 10160 are payable when billed with ICD-10-CM codes L02.611, L02.612 or L98.8 only.
CPT code 10140 is payable only when billed with the specified ICD-10-CM codes listed in the policy (multiple S- and L- codes for traumatic or specific skin conditions as enumerated).
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.

NGS-J6-L33563, Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

A56766, Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures

NOVITAS-JH-L34938, Removal of Benign Skin Lesions

NGS-JK-L33563, Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

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