Does L74.511 require prior authorization?

No, L74.511 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L74.511` — Primary focal hyperhidrosis, face

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For claims requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The medical record must include the ordering provider's assessment related to the visit, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.
For botulinum toxin coverage, medical records must document medical necessity for treatment.
For spastic conditions other than upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia or other focal dystonias, documentation must state the condition was unresponsive to conventional treatment and include the covered diagnosis, dosages, injection sites, frequencies, EMG necessity if used, and description of treatment effectiveness.

Medicare covers botulinum toxin injections for medically necessary treatment of spastic conditions including upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia, and other focal dystonias.
Medicare will reimburse unused portions of reconstituted botulinum toxin when the medical record documents the precise amount administered and the amount discarded.
No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
Botulinum toxin injections are covered when medical necessity is documented according to the Local Coverage Determination (LCD) 'Botulinum Toxin Types A and B' Indications and Limitations of Coverage.
Approved formulations include Botox (onabotulinumtoxinA), Dysport (abotulinumtoxinA), Xeomin (incobotulinumtoxinA), and Myobloc (rimabotulinumtoxinB); when a formulation is used for an indication not listed in the AHFS, a physician statement explaining the reason(s) for the unapproved form must be in the medical record.
Focal dystonia, hemifacial spasm, orofacial dyskinesia, blepharospasm, severe writer's cramp, laryngeal spasm, and dysphonia are recognized indications for which prior failure of traditional therapies is not required to document medical necessity.

L34635 — Botulinum Toxin Type A & Type B

J05

L39908 — Botulinum Toxin Injections

J05

A57474 — Billing and Coding: Botulinum Toxin Type A & Type B

J05

A59808 — Billing and Coding: Botulinum Toxin Injections

J05

A59706 — Billing and Coding: Botulinum Toxin Injections

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