Does D00.01 require prior authorization?

No, D00.01 does not require prior authorization (high confidence). Covered without prior authorization.

`D00.01`, Carcinoma in situ of labial mucosa and vermilion border

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

A CLIA certification number must be reported on all Mohs claims (item 23 on the CMS-1500 form or electronic equivalent).
The medical record must clearly document and support the circumstances when modifier -59 is used to distinguish a diagnostic biopsy from definitive Mohs surgery.
When appropriate to report modifier -59, report the modifier on the same line as the biopsy procedure codes and do not report -59 on the same line as the Mohs procedure.
Report the appropriate Mohs surgery code with quantities for the specimens mapped in the days/units field (units must reflect number of stages/blocks as applicable).

Bill CPT 17311-17315 for Mohs micrographic surgery when the surgeon removes the lesion and performs the intraoperative pathologic examination (surgeon prepares and interprets slides).
If the specimen(s) from the Mohs procedure are submitted to another physician (pathologist) who performs the frozen or permanent section examination, report the pathology by the performing pathologist (the service is not considered Mohs when the pathologist performs the exam).
Mohs micrographic surgery is covered when selected because the lesion's complexity (e.g., poorly defined borders, suspected deep invasion, recurrent lesion, prior radiation), size, or anatomic location requires maximal tissue conservation and other approaches (standard excision or destruction) are not medically reasonable or necessary.
Mohs surgery is considered covered when the surgeon performs both the surgical excision and the pathologic examination (surgeon acting in integrated surgical and pathology roles) as part of the Mohs technique.
Mohs Micrographic Surgery (MMS) is indicated for removal of complex or ill-defined malignant neoplasms of the skin requiring histopathologic examination of 100% of surgical margins.
MMS is indicated for lesions at critical anatomic sites (e.g., eyes, ears, nose, lips) where tissue-sparing technique and minimization of functional or cosmetic distortion are required.

CGS-J15-L34195, Mohs Micrographic Surgery

J15

CGS-J18-L34195, Mohs Micrographic Surgery

J18

A57477, Billing and Coding: Mohs Micrographic Surgery

WPS-J5-L35494, Mohs Micrographic Surgery

WPS-J5-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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