Does D04.60 require prior authorization?

No, D04.60 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D04.60`, Carcinoma in situ of skin of unspecified upper limb, including shoulder

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Maintain the complete medical record and make it available to the contractor upon request; every page must be legible and contain appropriate patient identification (e.g., full name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Destruction of a skin lesion is covered only when the medical record documents the lesion as malignant by a corresponding pathology report or a clinical description consistent with skin malignancy.
The medical record must include lesion size and lesion location to support medical necessity for destruction of a malignant skin lesion.
Services are covered only when they meet all applicable indications and limitations in LCD L33813, CMS payment policy manuals, any relevant national coverage determinations, and Medicare payment rules.
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.

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

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

WPS-J8-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

FIRST_COAST-L33813, Destruction of Malignant Skin Lesions

FIRST_COAST-L33818, Excision of Malignant Skin Lesions

FIRST_COAST-L33933, Peripheral Nerve Blocks

FIRST_COAST-L33689, Mohs Micrographic Surgery (MMS)

A57767, Billing and Coding: Mohs Micrographic Surgery (MMS)

A57660, Billing and Coding: Excision of Malignant Skin Lesions

A57638, Billing and Coding: Destruction of Malignant Skin Lesions

A57788, Billing and Coding: Peripheral Nerve Blocks

A58652, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

A58679, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

A56748, Billing and Coding: White Cell Colony Stimulating Factors