Does D81.818 require prior authorization?

No, D81.818 does not require prior authorization (high confidence). Covered without prior authorization.

`D81.818`, Other biotin-dependent carboxylase deficiency

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document medical necessity including relevant history, a precise physical examination, and results of pertinent diagnostic tests or procedures supporting the billed diagnoses.
Clinical documentation must show physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement and must document any co-existing systemic illness.
Physical exam notes must precisely document location, appearance, characteristics, and symptoms of nails and/or lesions; procedure notes must state what was done, how, and where and correlate treatments to documented lesions.
LOPS must be diagnosed by sensory testing using the 5.07 Semmes-Weinstein monofilament on five plantar sites per foot (randomized; avoid heavily callused areas); absence of sensation at two or more sites out of five on either foot documents peripheral neuropathy with LOPS.

Treatment of warts (including plantar warts) on the foot is covered to the same extent as wart treatment at other anatomic sites.
Foot care services that are a necessary and integral part of otherwise covered services (e.g., diagnosis or treatment of diabetic ulcers, wounds, or infections) are covered.
Routine foot care otherwise excluded may be covered when systemic conditions (metabolic, neurologic, or peripheral vascular disease) cause severe circulatory compromise or areas of diminished sensation and supporting Class A/B/C findings are documented.
Presumption of coverage for routine foot care exists when the provider documents either one Class A finding, two Class B findings, or one Class B plus two Class C findings as defined in the policy.
Debridement of mycotic toenails (CPT 11719, 11720, 11721; G0127) may be covered when the patient has qualifying systemic conditions with documentation of class findings and the appropriate modifier indicating a qualifying systemic illness causing peripheral neuropathy.
Payment may be made for debridement of a mycotic nail when definitive antifungal treatment options were reviewed and discussed with the patient at the initial visit and the attending physician documents that the criteria for debridement are met.

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

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CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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CGS-J18-L34246, Routine Foot Care and Debridement of Nails

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CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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