Does B46.9 require prior authorization?

No, B46.9 does not require prior authorization (high confidence). Covered without prior authorization.

`B46.9`, Zygomycosis, 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.
Myelodysplastic syndromes (MDS): Consideration of iron chelation (once‑daily subcutaneous deferoxamine or oral deferasirox) to decrease iron overload in IPSS Low or Intermediate‑1 patients who have received or are anticipated to receive > 20 RBC transfusions, patients for whom ongoing RBC transfusions are anticipated, and patients with serum ferritin > 2,500 ng/mL (aiming for target ferritin < 1,000 ng/mL as per NCCN guidance).
Thalassemia major and transfusion‑dependent anemias: Iron chelation therapy to prevent/treat transfusional iron overload (deferoxamine, deferasirox, etc.).
Renal failure with aluminum toxicity: Deferoxamine indicated for aluminum overload in dialysis patients (DFO shown to improve symptoms and bone histology).
Selected infectious or adjunctive uses described in literature: iron chelation as adjunct in management of zygomycosis (limited experience) and experimental/ investigational uses summarized (e.g., topical EDTA for cataract in animal/early studies).

FIRST_COAST-L33922, Nail Debridement

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

AETNA-CPB-0234, Chelation Therapy

A57672, Billing and Coding: Nail Debridement

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