Does D07.69 require prior authorization?

No, D07.69 does not require prior authorization (high confidence). Covered without prior authorization.

`D07.69`, Carcinoma in situ of other male genital organs

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Documentation must explain why the lesion will not be or was not managed by standard excision or destruction, and when applicable justify the selection of complex repair techniques (adjacent tissue transfer, flap, graft) or referral to plastic surgery.

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.
Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Lab-developed tests for inherited cancer syndromes in patients with cancer (per LCD L38966) are covered when billed with the required claim elements specified in this policy.
Coverage applies for lab-developed tests (LDTs) for inherited cancer syndromes in patients with cancer when billed in accordance with MolDX LCD L38972.
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.

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

WPS-J5-L35494, Mohs Micrographic Surgery

A57477, Billing and Coding: Mohs Micrographic Surgery

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