L98.9 — Disorder of the skin and subcutaneous tissue, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must include the appropriate CPT code, 1 unit of service (UOS), and the appropriate ICD-10-CM diagnosis code.
- Additional medical necessity documentation must be submitted when more than 24 markers are tested.
- Follow the associated Local Coverage Determination LCD L34215 for full documentation and coverage requirements not detailed here.
- All documentation must be maintained in the patient's medical record, legible, include patient identifiers (e.g., full name, dates of service), and contain the legible signature of the responsible physician or non-physician practitioner to support medical necessity.
Key Coverage Criteria
- Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
- Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
- Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.
- Reconstructive surgery is covered for abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, involutional defects, or disease when performed to improve function or approximate normal appearance.
- Removal of breast implant(s) is covered when the medical record documents a condition that makes removal medically reasonable and necessary.
- Breast reduction (reduction mammoplasty) is covered when clinical evaluation documents macromastia with signs/symptoms, height/weight and BSA are recorded, and back/neck/shoulder pain is unrelieved by at least 6 months of conservative treatment, with operative and pathology reports documenting the weight of tissue removed from each breast.
8 Active Policies
L39051 — Cosmetic and Reconstructive Surgery
J05
A58774 — Billing and Coding: Cosmetic and Reconstructive Surgery
J05
A57689 — Billing and Coding: Lab: Flow Cytometry
A59299 — Billing and Coding: Cosmetic and Reconstructive Surgery
L34215 — Lab: Flow Cytometry
Related Codes
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