Does B47.9 require prior authorization?

No, B47.9 does not require prior authorization (high confidence). Covered without prior authorization.

`B47.9`, Mycetoma, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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."
Avian influenza A virus (H5N1): documentation of symptoms consistent with Avian influenza A virus and history of travel to or contact with persons or birds from a country with documented H5N1 avian influenza infections within 10 days of symptom onset.
Cerebrospinal fluid (CSF) pathogen panel: Member has clinical findings consistent with a central nervous system (CNS) infection (e.g., meningitis, encephalitis); and viral etiology is suspected or the CSF culture is inconclusive for pathogen etiology (i.e., viral, bacterial, fungal).

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

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

AETNA-CPB-0383, Mohs Micrographic Surgery

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

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