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ICD-10-CM L81.0 — Postinflammatory hyperpigmentation | No Prior Auth

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`L81.0` — Postinflammatory hyperpigmentation

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

For any iontophoretic dermatologic or ophthalmologic application: documentation of agent(s) used, concentrations, device/model, current and duration parameters, and monitoring for local adverse effects (erythema, burns, corneal complications, etc.).
No documentation requirements are stated in this document chunk (bibliography).
For primary focal hyperhidrosis: documentation that the member is unresponsive to or unable to tolerate oral pharmacotherapy for excessive sweating (examples given: anti-cholinergics, beta-blockers, benzodiazepines).
For primary focal hyperhidrosis: documentation that significant disruption of professional and/or social life has occurred because of excessive sweating.

Key Coverage Criteria

(Inferred from references) Iontophoresis for treatment of rheumatoid arthritic knees
(Inferred from references) Transepithelial iontophoresis corneal collagen cross-linking for progressive keratoconus
(Inferred from references) Whole-finger iontophoresis to increase blood flow in systemic sclerosis
(Inferred from references) Transdermal iontophoretic drug delivery platforms/technologies (general)
(Inferred from references) Conservative treatments, including iontophoresis, for patellar tendinopathy
(Inferred from references) Alternatives to oral opioids for cancer/postoperative pain including fentanyl iontophoretic transdermal system (ITS)

2 Active Policies

AETNA-CPB-0229 — Iontophoresis

ANTHEM-CG-LAB-21 — CG-LAB-21 Serum Iron Testing

Related Codes

83540(1 policies)83550(1 policies)84466(1 policies)89230(1 policies)97033(1 policies)

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For primary focal hyperhidrosis: documentation that topical aluminum chloride or other extra-strength antiperspirants are ineffective or cause a severe rash.

For delivery of local anesthetic before emergent skin puncture/dermatologic procedures: documentation of emergent nature of procedure and rationale for iontophoretic local anesthesia (i.e., need for more rapid dermal anesthesia than topical agents).

A01.00(1 policies)

A02.9(1 policies)

82728(1 policies)