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ICD-10-CM B36.9, Superficial mycosis, unspecified | No Prior Auth

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`B36.9`, Superficial mycosis, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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."

Key Coverage Criteria

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

2 Active Policies

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

AETNA-CPB-0383, Mohs Micrographic Surgery

Related Codes

B36.0(2 policies)B48.8(2 policies)B48.0(2 policies)17313(1 policies)88331(1 policies)88332(1 policies)17315(1 policies)99183(1 policies)

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