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ICD-10-CM L72.9, Follicular cyst of the skin and subcutaneous tissue, unspecified | No Prior Auth

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`L72.9`, Follicular cyst of the skin and subcutaneous tissue, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

Key Coverage Criteria

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.

1 Active Policy

A56346, Billing and Coding: Removal of Benign and Malignant Skin Lesions

Related Codes

11301(1 policies)11302(1 policies)11303(1 policies)11305(1 policies)11306(1 policies)11307(1 policies)11308(1 policies)11300(1 policies)

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