Does D23.121 require prior authorization?

No, D23.121 does not require prior authorization (high confidence). Covered without prior authorization.

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`D23.121`, Other benign neoplasm of skin of left upper eyelid, including canthus

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

List the appropriate CPT code for the procedure and include any applicable modifiers; adhere to Medicare global surgery and CCI (correct coding initiative) rules for eyelid surgeries.
Submit physicians' services and diagnostic tests with a diagnosis code that supports medical necessity and code to the greatest level of specificity (full digit completeness).
Use the diagnosis code based on diagnostic test results as the primary diagnosis; if test results are normal or inconclusive, use the diagnosis code for the sign or symptom that prompted the test as the primary diagnosis.

Key Coverage Criteria

Blepharoplasty, blepharoptosis repair, or brow lift is covered when documented signs or symptoms of a functional abnormality of the upper eyelids are present as defined by the associated LCD (L34528).
CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Use CPT 11400-11446 when the excision is a full-thickness removal through the dermis including margins and including simple (non-layered) closure.
Use CPT 17110 for destruction of benign lesions other than skin tags or cutaneous vascular lesions for up to 14 lesions (report 1 unit).
Use CPT 17111 for destruction of benign lesions other than skin tags or cutaneous vascular lesions when 15 or more lesions are treated (report 1 unit).

20 Active Policies

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L33944, Blepharoplasty

J15

CGS-J15-L34393, Ocular Photography - External

J15

CGS-J18-L33944, Blepharoplasty

J18

CGS-J18-L34200, Removal of Benign Skin Lesions

J18

CGS-J18-L34393, Ocular Photography - External

J18

CGS-J18-L34037, Flow Cytometry

J18

WPS-J5-L34528, Blepharoplasty, Blepharoptosis and Brow Lift

WPS-J5-L35498, Removal of Benign Skin Lesions

A56908, Billing and Coding: Blepharoplasty, Blepharoptosis and Brow Lift

A57482, Billing and Coding: Removal of Benign Skin Lesions

A57452, Billing and Coding: Peripheral Nerve Blocks

NGS-J6-L36850, Peripheral Nerve Blocks

WPS-J8-L34528, Blepharoplasty, Blepharoptosis and Brow Lift

WPS-J8-L35498, Removal of Benign Skin Lesions

FIRST_COAST-L33933, Peripheral Nerve Blocks

NOVITAS-JH-L34938, Removal of Benign Skin Lesions

NGS-JK-L36850, Peripheral Nerve Blocks

NOVITAS-JL-L34938, Removal of Benign Skin Lesions

`D23.121`, Other benign neoplasm of skin of left upper eyelid, including canthus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

D23.121, Other benign neoplasm of skin of left upper eyelid, including canthus

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`D23.121`, Other benign neoplasm of skin of left upper eyelid, including canthus