Does C49.11 require prior authorization?

No, C49.11 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`C49.11`, Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

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.

Key Coverage Criteria

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.

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`C49.11`, Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C49.11, Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C49.11`, Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder