Does L57.0 require prior authorization?

No, L57.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L57.0`, Actinic keratosis

ICD-10-CM

No Prior Auth Required

Code is 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.
Medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.

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.
Excision of a benign skin lesion is covered when there is clinical suspicion of malignancy (e.g., ICD-10-CM D48.5) documented in the medical record.
Removal is covered to address disturbance of skin sensation when documented (ICD-10-CM R20.0-R20.3, R20.8).
Removal is covered when documented objective changes (e.g., increase in size) support a diagnosis warranting excision.
Removal of a benign lesion is covered when the treating physician documents medical necessity for removal (physician judgment that lesion merits removal).

CGS-J15-L39506, Cosmetic and Reconstructive Surgery

J15

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J18-L39506, Cosmetic and Reconstructive Surgery

J18

CGS-J18-L34200, Removal of Benign Skin Lesions

J18

A58774

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