L87.9 — Transepidermal elimination disorder, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This policy provides billing, coding, and guideline information that complements the Local Coverage Determination (LCD) 'Cosmetic and Reconstructive Surgery' L33428; the full policy content is not included here, so specific documentation requirements (e.g., medical records, prior authorizations, forms) are not available in the provided excerpt.
- Clinical records must clearly document medical necessity and an explicit rationale for why removal is not cosmetic when billing CPT 17106-17108.
- Coding and billing guidance must be used with the associated Local Coverage Determination; coverage details for CPT 11055-11057 are delineated in the Medicare Internet-Only Manual and should be followed for claims.
- Preoperative photographs may be required to support justification for abdominoplasty/panniculectomy and should be supplied upon request.
Key Coverage Criteria
- Removal of benign skin lesions billed with CPT 17106, 17107, or 17108 is covered only when clinical records document medical necessity and explicitly state why the procedure is not cosmetic.
- Treatment of hyperkeratotic lesions (e.g., corns and calluses) billed with CPT 11055, 11056, or 11057 is covered as described in the Medicare Internet-Only Manual.
- Dermabrasion is covered when used to correct skin defects resulting from traumatic injury, prior surgery, or disease.
- Septoplasty is covered for septal deviation causing nasal airway obstruction unresponsive to a recent trial of conservative medical management lasting at least 6 weeks.
- Septoplasty is covered for recurrent sinusitis secondary to a deviated septum that does not resolve after appropriate medical and antibiotic therapy.
- Reconstructive surgery is covered for abnormal structures caused by congenital defects, developmental abnormalities, trauma, surgery, infection, tumors, or disease when performed to improve function or approximate a normal appearance.
7 Active Policies
A57162 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
ANTHEM-CG-LAB-20 — CG-LAB-20 Thyroid Testing
A56658 — Billing and Coding: Cosmetic and Reconstructive Surgery
A57161 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
L34233 — Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
Related Codes
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