Does D00.08 require prior authorization?

No, D00.08 does not require prior authorization (high confidence). Covered without prior authorization.

`D00.08`, Carcinoma in situ of pharynx

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.
This article provides billing and coding guidelines that complement Local Coverage Determination (LCD) L37176 for White Cell Colony Stimulating Factors; refer to LCD L37176 for specific coverage criteria, indications, and limitations.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.

No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Excision of malignant or clinically ambiguous lesions with moderate-to-high suspicion that require moderate-to-wide grossly normal skin/soft-tissue margins should be coded using excision of malignant lesion including margins codes 11600-11646.
Excision of benign or low-clinical-suspicion lesions that are removed with minimal surrounding grossly normal skin/soft-tissue margins should be coded using excision of benign lesion codes 11400-11446.
Services are covered only when they meet all indications and limitations in LCD L33818, applicable CMS payment policy manuals, any CMS national coverage determinations, and Medicare payment rules.

A58756, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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

NGS-J6-L40334, Erythropoiesis Stimulating Agents

NGS-J6-L40333, Erythropoiesis Stimulating Agents

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