L95.1 — Erythema elevatum diutinum
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.
- Documentation supporting the claim must be maintained in the medical record and be available to Medicare upon request.
- Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and reasons for the service; claims without ICD-10-CM codes will be returned.
- For diagnostic tests related to the service, report the test result if known; if the result is not known, report the signs or symptoms that prompted the test.
Key Coverage Criteria
- Follow the related Local Coverage Determination (LCD) for clinical indications and medical necessity criteria for reduction mammaplasty.
- Excision of a benign skin lesion is covered when there is clinical suspicion of malignancy (e.g., ICD-10-CM D48.5) documented in the medical record.
- Removal is covered to address disturbance of skin sensation when documented (ICD-10-CM R20.0-R20.3, R20.8).
- Removal is covered when documented objective changes (e.g., increase in size) support a diagnosis warranting excision.
- Removal of a benign lesion is covered when the treating physician documents medical necessity for removal (physician judgment that lesion merits removal).
- Report histopathologic examination separately when performed using CPT codes 88304-88305.
20 Active Policies
L39051 — Cosmetic and Reconstructive Surgery
J05
A58774 — Billing and Coding: Cosmetic and Reconstructive Surgery
J05
L35001 — Reduction Mammaplasty
J06
A56837 — Billing and Coding: Reduction Mammaplasty
J06
A57113 — Billing and Coding: Removal of Benign Skin Lesions
Related Codes
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