Does B42.9 require prior authorization?

No, B42.9 does not require prior authorization (high confidence). Covered without prior authorization.

`B42.9`, Sporotrichosis, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be made available to the contractor upon request.
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
The provider must document the affected nail(s), clinical evidence of mycosis, and the manner and extent to which the nail(s) were debrided.

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.
Acanthamoeba in corneal ulceration
Actinomyces, for identification of actinomyces species in tissue specimens
Adenovirus, to diagnose adenovirus myocarditis, and to diagnose adenovirus infection in immunocompromised hosts, including transplant recipients
Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy

FIRST_COAST-L33922, Nail Debridement

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

A57672, Billing and Coding: Nail Debridement

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