Does L56.5 require prior authorization?

No, L56.5 does not require prior authorization (high confidence). Covered without prior authorization.

`L56.5`, Disseminated superficial actinic porokeratosis (DSAP)

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Legible medical records must reference the patient's complaint or the physician's physical findings when billing with diagnosis L82.0.
Documentation must support a significant, separately identifiable E/M service when modifier 25 is appended (separate E/M note tied to the visit and not just the procedure).
Verify applicable procedure and global policy coding via the Medicare Physician Fee Schedule Database (MPFSDB) to determine where the global surgical policy applies.
Maintain all documentation in the patient’s medical record and make it available to the contractor upon request.

Removal of benign or malignant skin lesions is addressed per the Local Coverage Determination L33445 and related billing/coding guidance.
Diagnosis code L82.0 (inflamed seborrheic keratosis) may be used when the medical record documents the patient's complaint or the physician's physical findings for the lesion.
Report histopathologic examination separately when performed using CPT codes 88304-88305.
Select the CPT code for lesion removal by measuring the greatest clinical diameter of the apparent lesion plus the margin required for complete excision, with measurement made prior to excision.
When shave removal is performed solely to obtain a pathologic diagnosis, report tangential (shave) biopsy CPT codes 11102-11103 instead of shave removal codes.
Follow the reasonable and necessary requirements in LCD L34938 for coverage determinations of benign skin lesion removal.

A57482, Billing and Coding: Removal of Benign Skin Lesions

WPS-J5-L35498, Removal of Benign Skin Lesions

WPS-J8-L35498, Removal of Benign Skin Lesions

NOVITAS-JH-L34938, Removal of Benign Skin Lesions

NOVITAS-JL-L34938

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