Does B36.0 require prior authorization?

No, B36.0 does not require prior authorization (high confidence). Covered without prior authorization.

`B36.0`, Pityriasis versicolor

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

No explicit "Documentation Requirements" section is provided in this Clinical Policy Bulletin.
Billing limitation/note that may affect documentation: "Mohs micrographic surgery requires a single physician to act in 2 integrated, but separate and distinct capacities: surgeon and pathologist. If either of these responsibilities is delegated to another physician who reports his/her services separately, the use of the Mohs micrographic surgery CPT codes is inappropriate."
For Barrett's esophagus carcinoma in-situ: documentation that member is not a candidate for esophagectomy (policy language: "Barrett's esophagus carcinoma in-situ and high-grade disease in members who are not candidates for esophagectomy").
For microinvasive endobronchial non-small cell lung cancer: documentation that surgery and radiotherapy are not indicated (policy language: "Microinvasive endobronchial non-small cell lung cancer at an early stage, for whom surgery and radiotherapy are not indicated").

Recurrent or incompletely excised malignant lesions, regardless of anatomic region
Aetna considers surgery with the Mohs technique medically necessary for any of the following skin conditions:
Areas of important tissue preservation (ears, face, feet, hands, genitalia, and perianal)
Atypical fibroxanthoma
Dermatofibrosarcoma protuberans
For exceptionally large (2 cm or larger in diameter) or rapidly growing lesions in any anatomic region

ANTHEM-CG-MED-73, Hyperbaric Oxygen Therapy (Systemic/Topical)

AETNA-CPB-0375, Photodynamic Therapy

AETNA-CPB-0383, Mohs Micrographic Surgery

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