Does D23.4 require prior authorization?

No, D23.4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D23.4`, Other benign neoplasm of skin of scalp and neck

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Legible medical records must reference the patient's complaint or the physician's physical findings when billing with diagnosis L82.0.
Documentation must support a significant, separately identifiable E/M service when modifier 25 is appended (separate E/M note tied to the visit and not just the procedure).
Verify applicable procedure and global policy coding via the Medicare Physician Fee Schedule Database (MPFSDB) to determine where the global surgical policy applies.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

Removal of benign or malignant skin lesions is addressed per the Local Coverage Determination L33445 and related billing/coding guidance.
Diagnosis code L82.0 (inflamed seborrheic keratosis) may be used when the medical record documents the patient's complaint or the physician's physical findings for the lesion.
CPT 88182 reports the physician professional and facility technical components of DNA ploidy and S-phase analysis of tumor by flow cytometry.
CPT 88184 (first marker) and CPT 88185 (each additional marker) report the facility technical component of flow cytometric immunophenotyping for assessment of potential hematolymphoid neoplasia.
Flow cytometry interpretation is reported using CPT codes 88187–88189 (one interpretation code per specimen).
Quantitative cell counts by flow cytometry are billed using CPT codes 86355, 86356, 86357, 86359, 86360, 86361, and 86367.

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L34200, Removal of Benign Skin Lesions

J18

WPS-J5-L35498, Removal of Benign Skin Lesions

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