Does L74.52 require prior authorization?

No, L74.52 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L74.52` — Secondary focal hyperhidrosis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement the Local Coverage Determination (LCD) L33458 for chemodenervation; follow LCD L33458 for specific coverage criteria and coding guidance.
Medical records must document the exact type and strength of botulinum toxin used (Botox, Dysport, Xeomin, or Myobloc) and the dosage administered.
Medical records must include a covered diagnosis per the LCD (or a physician statement explaining use for an indication not listed in the AHFS) and support for clinical effectiveness of the injections.
Except for the enumerated exceptions (focal dystonia, hemifacial spasm, orofacial dyskinesia, blepharospasm, severe writer's cramp, laryngeal spasm, dysphonia), the record must state that traditional methods of treatment have been tried and proven unsuccessful.

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.
Botulinum toxin injections are covered when the medical record documents medical necessity consistent with the associated LCD Botulinum Toxin Types A and B (L35172).
Covered botulinum toxin preparations include onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), and rimabotulinumtoxinB (Myobloc).
A statement that traditional methods of treatment have been tried and proven unsuccessful must be documented except for focal dystonia, hemifacial spasm, orofacial dyskinesia, blepharospasm, severe writer's cramp, laryngeal spasm, or dysphonia where such trials are not required.

A59808 — Billing and Coding: Botulinum Toxin Injections

J05

L39908 — Botulinum Toxin Injections

J05

A59706 — Billing and Coding: Botulinum Toxin Injections

J06

AETNA-CPB-0310 — Thoracoscopic Sympathectomy

AETNA-CPB-0504 — Hyperhydrosis

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