Does L74.9 require prior authorization?

No, L74.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L74.9` — Eccrine sweat disorder, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must fully document and support medical necessity per the LCD and include relevant history, physical examination, and pertinent diagnostic test results; insufficient documentation will result in denial as not reasonable and necessary.
When a referring or ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim.
When modifier JW is used to report a discarded portion of drug, the medical record must document the amount administered and the amount discarded.
Effective July 1, 2023, modifier JZ is required on all claims for drugs separately payable under Medicare Part B when there are no discarded amounts from single-dose containers or single-use packages; documentation must be available to the contractor upon request.

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.
Botulinum toxin injections are covered when billed with the appropriate injection/destruction CPT code(s) in conjunction with the corresponding HCPCS J-code for the product administered (J0585, J0586, J0587, J0588 or J0589) and a valid ICD-10-CM diagnosis that supports medical necessity per the LCD.
Electromyography (EMG) guidance for injections is covered when medically necessary and billed with CPT 95873 (or 95874 when applicable but not together with 95873) in conjunction with the appropriate injection CPT codes.
EMG to guide chemodenervation for strabismus is covered when billed with CPT 92265.

L39908 — Botulinum Toxin Injections

J05

A59808 — Billing and Coding: Botulinum Toxin Injections

J05

A59706 — Billing and Coding: Botulinum Toxin Injections

J06

A59727 — Billing and Coding: Botulinum Toxin Injections

A59728 — Billing and Coding: Botulinum Toxin Injections

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