Does D04.22 require prior authorization?

No, D04.22 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`D04.22`, Carcinoma in situ of skin of left ear and external auricular canal

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Operative notes and pathology documentation must clearly show that Mohs was performed using accepted technique and that the surgeon acted in both surgical and pathology capacities.
Medical record must document location, number, and size of lesion(s); number of stages performed; and number of specimens per stage.
Histology documentation must include for the first stage: presence of tumor, depth of invasion, pathological pattern, cell morphology, and perineural invasion if present; subsequent stages must note if characteristics are same or describe differences.

Key Coverage Criteria

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.
Lab-developed tests for inherited cancer syndromes in patients with cancer as described in Local Coverage Determination (LCD) L39040 are the services addressed by this billing/coding guidance.
SRT is covered when used as the primary treatment modality for a cutaneous low-risk or high-risk basal cell carcinoma (BCC) per NCCN/ASTRO/AAD guidelines, with documented medical necessity and documentation that the patient is a nonsurgical candidate.
SRT is covered when used as the primary treatment modality for a cutaneous low-risk or high-risk squamous cell carcinoma (SCC) per NCCN/ASTRO/AAD guidelines, with documented medical necessity and documentation that the patient is a nonsurgical candidate.
SRT is covered when used as the primary treatment modality for cutaneous squamous cell carcinoma in situ (SCC in situ) per NCCN/ASTRO/AAD guidelines, with documented medical necessity and documentation that the patient is a nonsurgical candidate.

20 Active Policies

CGS-J15-L34195, Mohs Micrographic Surgery

J15

CGS-J15-L40179, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

J15

CGS-J15-L40178, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J18-L40179, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

J18

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L34195, Mohs Micrographic Surgery

J18

CGS-J18-L40178, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

J18

WPS-J5-L35494, Mohs Micrographic Surgery

WPS-J5-L40193, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

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

A57477, Billing and Coding: Mohs Micrographic Surgery

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

WPS-J5-L40192, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

NGS-J6-L40333, Erythropoiesis Stimulating Agents

NGS-J6-L40168, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

NGS-J6-L40167, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

NGS-J6-L40334, Erythropoiesis Stimulating Agents

WPS-J8-L40192, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

WPS-J8-L40193, Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma Skin Cancers (NMSC)

`D04.22`, Carcinoma in situ of skin of left ear and external auricular canal

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

D04.22, Carcinoma in situ of skin of left ear and external auricular canal

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`D04.22`, Carcinoma in situ of skin of left ear and external auricular canal