Does L94.9 require prior authorization?

No, L94.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L94.9` — Localized connective tissue disorder, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
The condition(s) that make removal medically necessary must be "clearly documented in the medical record."
Documentation of lesion characteristics when used to justify medical necessity (e.g., bleeding, intense itching, pain).

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.
This policy applies to the following: seborrheic keratoses, skin tags, milia, molluscum contagiosum, sebaceous (epidermoid) cysts, moles (nevi), acquired hyperkeratosis (keratoderma) and viral warts (excluding condyloma acuminatum).
Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or more of the following conditions is present and clearly documented in the medical record:
A. The lesion has one or more of the following characteristics: bleeding
A. The lesion has one or more of the following characteristics: intense itching

A57162 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

A57161 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

L34233 — Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

L33979 — Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

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