Does L10.4 require prior authorization?

No, L10.4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L10.4`, Pemphigus erythematosus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim.
The diagnosis code(s) submitted must accurately and specifically describe the patient's condition for which the visual electrophysiology test was performed.

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Off-label use of rituximab or rituximab biosimilars is allowable when the patient has documented lack of efficacy of prior treatments, including dosing, frequency, duration, and documentation of response(s).
Off-label use is allowable when first-line therapy produced an adverse reaction that absolutely contraindicates further use or causes non-transient side effects that impair functional capacity or activities of daily living, with the adverse event documented.
Off-label use is allowable for refractory disease when documentation includes all first-line treatment(s) with dosing, frequency, duration, and documentation of response(s).

CGS-J15-L35891, Intravenous Immune Globulin

J15

CGS-J15-L38992, Electroretinography (ERG)

J15

CGS-J18-L35891, Intravenous Immune Globulin

J18

CGS-J18-L38992, Electroretinography (ERG)

J18

A57599, Billing and Coding: Visual Electrophysiology Testing

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