Does L12.31 require prior authorization?

No, L12.31 does not require prior authorization (high confidence). Covered without prior authorization.

`L12.31`, Epidermolysis bullosa due to drug

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Clinical records must clearly document medical necessity and an explicit rationale for why removal is not cosmetic when billing CPT 17106-17108.
Coding and billing guidance must be used with the associated Local Coverage Determination; coverage details for CPT 11055-11057 are delineated in the Medicare Internet-Only Manual and should be followed for claims.
Medical records must document the indication(s) supporting use of IVIG for each claim.
For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.

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.
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.
IVIG may be indicated for pure red cell aplasia–related anemia.
Intramuscular immune globulin (gamma globulin) is indicated for post-exposure prophylaxis to hepatitis A.
IG is indicated for measles (rubeola) post-exposure prophylaxis in susceptible patients exposed less than 3 days prior to treatment.

WPS-J5-L34771, Immune Globulins

A57554, Billing and Coding: Immune Globulins

WPS-J8-L34771, Immune Globulins

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.