Does H61.001 require prior authorization?

No, H61.001 does not require prior authorization (high confidence). Covered without prior authorization.

`H61.001`, Unspecified perichondritis of right external ear

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.
Ensure every page of the record is legible and includes appropriate patient identification information, such as complete name and dates of service.
Include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Report histopathologic examination separately when performed using CPT codes 88304-88305.
Select the CPT code for lesion removal by measuring the greatest clinical diameter of the apparent lesion plus the margin required for complete excision, with measurement made prior to excision.
When shave removal is performed solely to obtain a pathologic diagnosis, report tangential (shave) biopsy CPT codes 11102-11103 instead of shave removal codes.
Follow the reasonable and necessary requirements in LCD L34938 for coverage determinations of benign skin lesion removal.
Removal of benign skin lesions billed with CPT 17106, 17107, or 17108 is covered only when clinical records document medical necessity and explicitly state why the procedure is not cosmetic.
Treatment of hyperkeratotic lesions (e.g., corns and calluses) billed with CPT 11055, 11056, or 11057 is covered as described in the Medicare Internet-Only Manual.

NOVITAS-JH-L34938, Removal of Benign Skin Lesions

NOVITAS-JL-L34938, Removal of Benign Skin Lesions

A57113, Billing and Coding: Removal of Benign Skin Lesions

A57161, Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

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