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ICD-10-CM L51.9, Erythema multiforme, unspecified | No Prior Auth

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`L51.9`, Erythema multiforme, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

No explicit documentation requirements are stated in the provided text.
Implied: documentation demonstrating an objective functional impairment is required to justify reconstructive surgery (e.g., clinical notes, functional assessment).
No documentation requirements (medical records, test results, or specific clinical documentation) are stated in this excerpt.
Refer to CMS Medicare Coverage Database for the most current applicable CMS NCD/LCD/LCA.

Key Coverage Criteria

Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 Covered Medical and Other Health Services; Section 120 Prosthetic Devices — §120C Prosthetic Devices (Dentures) (reference in document implies coverage of prosthetic devices/dentures under Medicare prosthetic policy).
NCD 250.5: Dermal Injections for Facial Lipodystrophy Syndrome (LDS) (document references this NCD title).
Disease (eg, auricular perichondritis, infection, tumor)
21084 Impression and custom preparation; speech aid prosthesis
CPT 11960 - Insertion of tissue expander(s) for other than breast, including subsequent expansion
CPT 11970 - Replacement of tissue expander with permanent implant

1 Active Policy

HUMANA-COSMETIC-AND-RECONSTRUCTIVE-SURGERY-MA, Cosmetic and Reconstructive Surgery

Related Codes

15780(1 policies)17311(1 policies)L26.9(1 policies)

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Refer to the CMS website for the most current applicable CMS Online Manual System (IOMs) and Transmittals.

Humana and subsidiaries apply a Medicare Administrative Contractor's (MAC's) LCD to all requests (both Part A and Part B services) within the MAC's applicable geographic jurisdiction.