Does B48.1 require prior authorization?

No, B48.1 does not require prior authorization (high confidence). Covered without prior authorization.

`B48.1`, Rhinosporidiosis

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.
Coblation of soft tissue stenosis of the external auditory canal (EAC) (case series in children with congenital/acquired EAC occlusion showing patency and symptom resolution).
Cordotomy by Coblation (Coblator cordotomy) for treatment of bilateral vocal fold immobility (BVFI) to improve airway (multiple series including larger retrospective series reporting de-cannulation and improved Dyspnea Index/VHI outcomes).
Coblation (RF cold ablation) for recurrent laryngotracheal respiratory papillomatosis (small series reporting longer intervals between interventions vs CO2 laser).
Low-temperature RF Coblation for select early-stage glottic cancer (small series reporting feasibility, voice preservation, and no major complications in short follow-up).

FIRST_COAST-L33922, Nail Debridement

AETNA-CPB-0475, Coblation

A57672, Billing and Coding: Nail Debridement

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