Does L8045 require prior authorization?

Yes, L8045 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`L8045`, Auricular prosthesis, provided by a non-physician

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

A completed Standard Written Order (SWO) must be communicated to the supplier before claim submission; for items requiring WOPD the SWO must be signed prior to delivery.
Suppliers must maintain Proof of Delivery (POD) documentation and make POD available to the Medicare contractor upon request.
Claims must comply with CMS HCPCS coding guidelines, LCDs, LCD-related Policy Articles, and DME MAC articles; suppliers should follow the LCD-related Standard Documentation Requirements Article and the LCD-related Policy Article and the Supplier Manual for additional documentation requirements.
Suppliers should refer to DME MAC websites and bulletin articles for additional documentation and payment rule guidance relevant to this LCD.

Facial prosthesis is covered when there is loss or absence of facial tissue due to disease, trauma, surgery, or a congenital defect.
Any item is covered only if it is in a defined Medicare benefit category and is reasonable and necessary for diagnosis or treatment of illness or injury or to improve functioning of a malformed body member.
the procedure is reasonably expected to improve the functional impairment;and
an audiogram documents a loss of at least 15 decibels in the affected ear(s).
Facial plastic surgery is consideredmedically necessarywhen required tocorrect a significant functional impairmentandthe procedure can be reasonably expected to improve the functional impairment. Examples include, but are not limited to, reconstructive procedures which correct or improve a significant functional impairment of speech, nutrition, control of secretions, protection of the airway, or corneal protection.
Facial plastic surgery is consideredreconstructivewhen intended to address a significant variation from normal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect.Note:The initial restoration may be completed in stages.

ANTHEM-MP-A050276, ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck

ANTHEM-CG-MED-96, Prefabricated External Infant Ear Molding Systems

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

L33738, Facial Prostheses

AMBETTER-CP.MP.107

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