Does E75.26 require prior authorization?

No, E75.26 does not require prior authorization (high confidence). Covered without prior authorization.

`E75.26`, Sulfatase deficiency

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For debridement of mycotic nails, the medical record must describe each affected nail (size including thickness, color) and the local symptomatology attributable to each nail for that service encounter.
The patient's medical record must include assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report for the service.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim; for Part B claims, the attending physician name and NPI and the date last seen (MM/DD/YYYY) must be reported for ICD-10 codes under the active care requirement.
When billing Part A inpatient hospital claims, report the principal diagnosis in UB-04 FL67 and admitting diagnosis in FL69; for outpatient hospital claims report the full ICD-10-CM code in FL67 and additional diagnoses in FL67A-67Q as applicable.

Routine foot care and debridement of nails are payable under Medicare Part B when performed in approved places of service (POS 11,12,13,14,19,20[11720/11721 only],21,22,24,31,32,33,49,51,52,53,54,55,56,61,62,65,71,99).
Debridement of mycotic (onychomycosis/dermatophytosis) nails is covered only when the claim lists a primary diagnosis of dermatophytosis of the nail plus either a secondary systemic condition or an ICD-10-CM code from the LCD 'ICD-10-CM Codes that Support Medical Necessity' indicating secondary infection or pain.
Procedures to treat onychogryphosis or onychauxis are covered when the primary diagnosis is onychogryphosis or onychauxis and a secondary diagnosis from the LCD indicating secondary infection or pain is also reported.
Removal of benign hyperkeratotic lesions performed by cutting/parring is reported with CPT 11055, 11056, or 11057 and is the appropriate code set for hyperkeratotic plaques of the foot.
Removal of epidermal and dermal lesions by shaving is reported with CPT 11300–11313 when full-thickness excision is not performed and when anesthesia and hemostasis are provided.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.

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

J15

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

J18

ANTHEM-CG-LAB-20, Thyroid Testing

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

ANTHEM-CG-LAB-21, Serum Iron Testing

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