L81.3 — Cafe au lait spots
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Clinical documentation of signs and/or symptoms consistent with a genetic disorder.
- Documentation that prior clinical evaluation and standard laboratory tests and/or imaging were non-diagnostic or inconclusive.
- Documentation that test results are expected to inform clinical management or obviate further diagnostic testing.
- Providers must reference the most up-to-date sources of professional coding guidance prior to claim submission.
Key Coverage Criteria
- Genetic testing for Legius syndrome.
- Lymphangioleiomyomatosis (LAM) consistent with clinical diagnostic criteria.
- Multiple retinal nodular hamartomas identified on ophthalmologic exam.
- Two or more renal angiomyolipomas.
- Presence of a Shagreen patch (connective tissue nevus).
- Presence of 'confetti' skin lesions (numerous 1–3 mm hypopigmented macules).
1 Active Policy
AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1 — Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.