Does C44.1091 require prior authorization?

No, C44.1091 does not require prior authorization (high confidence). Covered without prior authorization.

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`C44.1091`, Unspecified malignant neoplasm of skin of left upper eyelid, including canthus

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document patient complaints and pertinent examination findings that justify functional blepharoplasty, addressing signs/symptoms associated with ptosis, pseudoptosis, blepharochalasis, and dermatochalasis (e.g., difficulty reading, seeing upper lid skin, or peripheral object detection).
Superior visual field testing must demonstrate a minimum of 12 degrees OR a 30 percent loss of the upper visual field with the upper lid in repose, and repeat testing with the upper lid taped (elevated) to demonstrate potential correction by the proposed procedure(s).
Photographs may be used to document eyelid abnormalities but are not required; photographic documentation is necessary in cases of prosthesis-related problems and is not separately reimbursable.

Key Coverage Criteria

Blepharoplasty is covered for blepharochalasis when chronic recurrent eyelid edema has produced excess skin requiring functional repair.
Upper blepharoplasty is considered reconstructive and covered when excess upper eyelid tissue or abnormally low upper lid position produces functional visual complaints (e.g., interference with primary or downgaze reading or superior/lateral visual field loss).
Blepharoplasty is covered for dermatochalasis, including symptomatic redundant skin weighing down on the upper eyelashes and surgically induced dermatochalasis after ptosis repair.
Blepharoptosis repair (ptosis surgery) is covered when aponeurotic dehiscence or other ptosis causes obstruct the superior visual field or visual axis in downgaze (reading position), including dehiscence after trauma or cataract extraction.
Brow ptosis repair is covered when brow ptosis contributes to significant superior visual field loss and brow repair is necessary for adequate functional result (may be done in conjunction with blepharoplasty/ptosis repair).
Blepharoplasty/eyelid surgery is covered to reconstruct anatomical or pathological defects caused by disease (including thyroid dysfunction and cranial nerve palsies), trauma, or tumor-ablative surgery when reconstruction protects the eye or improves visual function.

20 Active Policies

CGS-J15-L34195, Mohs Micrographic Surgery

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CGS-J15-L36658, Proton Beam Therapy

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

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CGS-J15-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

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CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

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

J15

CGS-J15-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

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CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L33944, Blepharoplasty

J15

CGS-J18-L34356, Erythropoiesis Stimulating Agents (ESA)

J18

CGS-J18-L34195, Mohs Micrographic Surgery

J18

CGS-J18-L40386, Erythropoiesis Stimulating Agents (ESA)

J18

CGS-J18-L38822, MolDX: Minimal Residual Disease Testing for Cancer

J18

CGS-J18-L36658, Proton Beam Therapy

J18

CGS-J18-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

J18

CGS-J18-L38065, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J18

CGS-J18-L33944, Blepharoplasty

J18

CGS-J18-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J18

WPS-J5-L34528, Blepharoplasty, Blepharoptosis and Brow Lift

WPS-J5-L35494, Mohs Micrographic Surgery

`C44.1091`, Unspecified malignant neoplasm of skin of left upper eyelid, including canthus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C44.1091, Unspecified malignant neoplasm of skin of left upper eyelid, including canthus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C44.1091`, Unspecified malignant neoplasm of skin of left upper eyelid, including canthus