Does L12.35 require prior authorization?

No, L12.35 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L12.35`, Other acquired epidermolysis bullosa

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims missing required NOC narrative information or with incorrect unit reporting will be rejected as unprocessable and may show remark code M123.
All documentation must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and be produced upon contractor request.
Medical records must include the legible signature of the physician or non-physician practitioner responsible for the care.
The submitted medical record must support the ICD-10-CM code(s), the CPT/HCPCS code(s) billed, and the medical necessity of services as stated in the applicable NCD and LCD.

Billing and coding guidance in this article applies when immune globulin use meets the reasonable and necessary coverage criteria established in LCD L35093.
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.
Coverage requires documentation that the immune globulin therapy is reasonable and necessary in accordance with LCD L34007 and applicable NCDs.
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.

A57554, Billing and Coding: Immune Globulins

WPS-J5-L34771, Immune Globulins

WPS-J8-L34771, Immune Globulins

FIRST_COAST-L34007, Immune Globulin

A57778, Billing and Coding: Immune Globulin

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