Does L20.9 require prior authorization?

No, L20.9 does not require prior authorization (high confidence). Covered without prior authorization.

`L20.9`, Atopic dermatitis, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Policy references and complements Local Coverage Determination L33417 for Allergy Skin Testing; full LCD and policy text required to determine specific documentation and billing rules.
Supportive documentation evidencing the condition and treatment must be documented in the medical record and be available to the Contractor upon request.
ICD-10-CM diagnosis codes supporting the medical necessity of the service must be submitted with each claim.
High-utilization or repeat testing should include clinical justification in the record (for example, repeat testing due to unsatisfactory response to treatment) to support medical necessity.

Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).
Exceeding the stated testing parameters may be covered when preliminary testing failed and immunotherapy failed to control symptoms, provided documentation supports medical necessity.
ICD-10 D59.3: Hemolytic-uremic syndrome [with clinical evidence of serious bleeding with platelet count below 50,000 or the potential for serious bleeding with platelet count below 20,000] (covered if selection criteria are met)
ICD-10 D69.3: Immune thrombocytopenic purpura [idiopathic thrombocytopenic purpura (ITP) with clinical evidence of serious bleeding with platelet count below 50,000 or the potential for serious bleeding with platelet count below 20,000] (covered if selection criteria are met)

ANTHEM-CG-DME-41, Ultraviolet Light Therapy Delivery Devices for Home Use

AMBETTER-CP.MP.100, Allergy Testing

AETNA-CPB-0174, Pool Therapy, Aquatic Therapy or Hydrotherapy

AETNA-CPB-0241, Extracorporeal Photochemotherapy (Photopheresis)

AETNA-CPB-0300, Hair Analysis

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