Does L51.2 require prior authorization?

No, L51.2 does not require prior authorization (high confidence). Covered without prior authorization.

`L51.2`, Toxic epidermal necrolysis [Lyell]

ICD-10-CM

No Prior Auth Required

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.
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).

A57554, Billing and Coding: Immune Globulins

WPS-J5-L34771, Immune Globulins

NGS-J6-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

A59101, Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

A59105

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