Does D36.9 require prior authorization?

No, D36.9 does not require prior authorization (high confidence). Covered without prior authorization.

`D36.9`, Benign neoplasm, unspecified site

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 acquired nevi (moles) when any of the selection criteria below are met.
Removal of small congenital nevi (less than 1.5 cm) when any of the selection criteria below are met.
Removal of cutaneous and subcutaneous neurofibromas when any of the selection criteria below are met.
Removal of dermatofibromas when any of the selection criteria below are met.
Removal of dermatosis papulosa nigra when any of the selection criteria below are met.

FIRST_COAST-L33933, Peripheral Nerve Blocks

ANTHEM-CG-LAB-21, Serum Iron Testing

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

AETNA-CPB-0633, Benign Skin Lesion Removal

A57788, Billing and Coding: Peripheral Nerve Blocks

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