L51.9 — Erythema multiforme, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No explicit documentation requirements are stated in the provided text.
- Implied: documentation demonstrating an objective functional impairment is required to justify reconstructive surgery (e.g., clinical notes, functional assessment).
- No documentation requirements (medical records, test results, or specific clinical documentation) are stated in this excerpt.
- Refer to CMS Medicare Coverage Database for the most current applicable CMS NCD/LCD/LCA.
Key Coverage Criteria
- Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 Covered Medical and Other Health Services; Section 120 Prosthetic Devices — §120C Prosthetic Devices (Dentures) (reference in document implies coverage of prosthetic devices/dentures under Medicare prosthetic policy).
- NCD 250.5: Dermal Injections for Facial Lipodystrophy Syndrome (LDS) (document references this NCD title).
- Disease (eg, auricular perichondritis, infection, tumor)
- 21084 Impression and custom preparation; speech aid prosthesis
- CPT 11960 - Insertion of tissue expander(s) for other than breast, including subsequent expansion
- CPT 11970 - Replacement of tissue expander with permanent implant
1 Active Policy
HUMANA-COSMETIC-AND-RECONSTRUCTIVE-SURGERY-MA — Cosmetic and Reconstructive Surgery - Medicare Advantage
Related Codes
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