Does L74.519 require prior authorization?

No, L74.519 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L74.519` — Primary focal hyperhidrosis, unspecified

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 medically necessary as defined by the Local Coverage Determination (LCD) 'Indications of Coverage' and when supported in the patient's medical record.
Electromyography (EMG) needle guidance using CPT 95873 or 95874 is covered when medically necessary in conjunction with qualifying injection CPT codes; CPT 95874 must not be reported with CPT 95873.
Electromyography used to guide chemodenervation for strabismus may be reported and covered with CPT 92265 when medically necessary.

A59808 — Billing and Coding: Botulinum Toxin Injections

J05

L39908 — Botulinum Toxin Injections

J05

A59706 — Billing and Coding: Botulinum Toxin Injections

J06

AETNA-CPB-0504 — Hyperhydrosis

ANTHEM-CG-SURG-116 — CG-SURG-116 Surgical Treatment of Hyperhidrosis

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