Does C44.309 require prior authorization?

No, C44.309 does not require prior authorization (high confidence). Covered without prior authorization.

`C44.309`, Unspecified malignant neoplasm of skin of other parts of face

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
For anophthalmic/microphthalmic/enophthalmic sockets, documentation must include subjective complaints, examination findings, failure of prosthesis modification when indicated, and photographic documentation showing how orbital/globe abnormalities relate to eyelid position and prosthesis intolerance.

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.

CGS-J15-L34195, Mohs Micrographic Surgery

J15

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

J15

CGS-J15-L39506, Cosmetic and Reconstructive Surgery

J15

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

J15

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