Does B47.0 require prior authorization?

No, B47.0 does not require prior authorization (high confidence). Covered without prior authorization.

`B47.0`, Eumycetoma

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
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.

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:
Areas of important tissue preservation (ears, face, feet, hands, genitalia, and perianal)
Atypical fibroxanthoma

FIRST_COAST-L33922, Nail Debridement

ANTHEM-CG-SURG-24, Functional Endoscopic Sinus Surgery (FESS)

AETNA-CPB-0383, Mohs Micrographic Surgery

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A57672, Billing and Coding: Nail Debridement

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