Does B49 require prior authorization?

No, B49 does not require prior authorization (high confidence). Covered without prior authorization.

`B49`, Unspecified mycosis

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.
Assessment of anterior chamber angle (ACA) configuration and detection of occludable/angle-closure (anterior segment OCT (AS-OCT) may be used for assessment of the anterior chamber angle and as a rapid screening tool for detection of occludable angles; cited studies include Nolan et al. 2007, Pekmezci et al. 2009, Desmond et al. 2022)
None. (The CPB states anterior segment OCT is considered experimental and investigational for all indications; see Limitations below.)
In vivo imaging and measurement of anterior segment ocular structures such as corneal and LASIK flap thickness (Visante OCT indication: "indicated for the in vivo imaging and measurement of ocular structures in the anterior segment such as corneal and laser in situ keratomileusis (LASIK) flap thickness (FDA, 2005).")
Measurement of central corneal thickness (CCT) and para-central corneal thickness (PCCT) (comparative studies vs ultrasound pachymetry and Orbscan II cited: Zhao et al. 2007; Li et al. 2007; Ho et al. 2007)

FIRST_COAST-L33922, Nail Debridement

AETNA-CPB-0556, Bio-Surgery: Medicinal Leech Therapy and Medical Maggots

AETNA-CPB-0749, Anterior Segment Scanning Computerized Ophthalmic Diagnostic Imaging

A57672, Billing and Coding: Nail Debridement

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