Does C43.61 require prior authorization?

No, C43.61 does not require prior authorization (high confidence). Covered without prior authorization.

`C43.61`, Malignant melanoma of right upper limb, including shoulder

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation must demonstrate that the physician performing Mohs micrographic surgery furnished both the surgical and the histologic (pathologic) evaluation of the specimen(s).
When a denial is likely based on medical necessity or other coverage reasons, the provider/supplier must notify the beneficiary in writing prior to rendering the service.
Document Hgb and/or Hct values to support initiation and maintenance of ESA therapy (including Hgb immediately prior to initiation for chemotherapy patients).
Before starting ESA therapy, consider, document, and correct reversible causes of anemia: iron deficiency, infection/inflammation, hematologic disease, hemolysis, vitamin deficiencies (folate/B12), blood loss, and aluminum intoxication.

Mohs micrographic surgery is covered for basal cell carcinoma located in the mask area of the face (central face, eyelids, eyebrows, periorbital areas, nose, lips, chin, mandible, periauricular areas, ear, temple, sulci).
Mohs micrographic surgery is covered for basal cell, squamous cell, or basalosquamous cell carcinomas on the forehead, cheeks, or neck.
Mohs micrographic surgery is covered for basal cell, squamous cell, or basalosquamous cell carcinomas of the genitalia.
Mohs micrographic surgery is covered for basal cell, squamous cell, or basalosquamous cell carcinomas of the hands or feet.
Mohs micrographic surgery is covered for basal cell, squamous cell, or basalosquamous cell carcinomas of the scalp.
Mohs micrographic surgery is covered for basal cell, squamous cell, or basalosquamous cell carcinomas that are recurrent tumors.

CGS-J15-L38822, MolDX: Minimal Residual Disease Testing for Cancer

J15

CGS-J15-L38065, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J15

CGS-J15-L39017, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J15

CGS-J15-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J15

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