L72.9 — Follicular cyst of the skin and subcutaneous tissue, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Legible medical records must reference the patient's complaint or the physician's physical findings when billing with diagnosis L82.0.
- Documentation must support a significant, separately identifiable E/M service when modifier 25 is appended (separate E/M note tied to the visit and not just the procedure).
- Verify applicable procedure and global policy coding via the Medicare Physician Fee Schedule Database (MPFSDB) to determine where the global surgical policy applies.
- Medical record must clearly document one or more medical necessity criteria (bleeding, persistent/intense itching, pain, inflammation, obstruction/vision restriction, diagnostic uncertainty, or recurrent trauma) when claiming removal of a benign lesion.
Key Coverage Criteria
- Removal of benign or malignant skin lesions is addressed per the Local Coverage Determination L33445 and related billing/coding guidance.
- Diagnosis code L82.0 (inflamed seborrheic keratosis) may be used when the medical record documents the patient's complaint or the physician's physical findings for the lesion.
- Removal of any malignant skin lesion is considered medically necessary and covered.
- Removal of actinic keratoses is covered when the procedure meets the requirements in CMS NCD Manual, Chapter 1, Part 4, §250.4.
- Removal of benign seborrheic keratoses, sebaceous cysts, or viral warts is covered if the lesion bleeds and this bleeding is documented.
- Removal of benign seborrheic keratoses, sebaceous cysts, or viral warts is covered if the lesion causes persistent or intense itching and this is documented.
2 Active Policies
A56346 — Billing and Coding: Removal of Benign and Malignant Skin Lesions
L33445 — Removal of Benign and Malignant Skin Lesions
Related Codes
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