Does D16.00 require prior authorization?

No, D16.00 does not require prior authorization (high confidence). Covered without prior authorization.

`D16.00`, Benign neoplasm of scapula and long bones of unspecified upper limb

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
Medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Documentation should state whether the block was performed for diagnostic or therapeutic purposes.

Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Removal of other primary or metastatic malignant neoplasms, when removal of the neoplasm may be curative, and the member is unable to tolerate surgical resection;
Radiofrequency ablation (RFA) for adrenal gland
Cancer bone pain, management of refractory bone pain in persons with cancer;
Malignant lung masses, in persons who are not candidates for surgical intervention;
Medullary thyroid carcinoma, treatment of distant metastases;

FIRST_COAST-L33933, Peripheral Nerve Blocks

ANTHEM-CG-SURG-61, Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver

AETNA-CPB-0492, Radiofrequency Tumor Ablation

A57788, Billing and Coding: Peripheral Nerve Blocks

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