Does B37.2 require prior authorization?

No, B37.2 does not require prior authorization (high confidence). Covered without prior authorization.

`B37.2`, Candidiasis of skin and nail

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For reduction mammoplasty, the medical record must include height and weight of the beneficiary.
For reduction mammoplasty, include a clinical evaluation documenting signs and/or symptoms ascribed to macromastia, therapies tried prior to surgery, and responses to those therapies.
For reduction mammoplasty, document severity and impact on health-related quality of life using an accepted breast-specific questionnaire.
Operative report must document the weight of tissue removed from each breast (measured in the operating room) and the pathology report for tissue removed must be included in the record.

Reconstructive plastic surgery is covered when performed for therapeutic purposes such as treatment of severe burns, facial repair following auto trauma, or similar reconstructive/therapeutic surgery.
Reduction mammoplasty is covered when the beneficiary has symptomatic breast hypertrophy (macromastia) with documented severe symptoms and demonstrable adverse impact on health-related quality of life as measured by an accepted breast-specific questionnaire, AND persistent signs/symptoms despite a reasonable trial of conservative therapy.
Nail debridement is covered only when the service meets all indications and limitations specified in LCD L33922 and applicable CMS medical necessity and payment rules.
Nail debridement for symptomatic mycotic nails is covered when there is documented clinical evidence of mycosis and qualifying symptoms for toenail debridement.
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:

FIRST_COAST-L33922, Nail Debridement

AETNA-CPB-0383, Mohs Micrographic Surgery

A57221, Billing and Coding: Plastic Surgery

A57672, Billing and Coding: Nail Debridement

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