Does L81.4 require prior authorization?

No, L81.4 does not require prior authorization (high confidence). Covered without prior authorization.

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`L81.4`, Other melanin hyperpigmentation

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Maintain all documentation in the patient’s medical record and make it available to the contractor upon request.
Ensure every page of the record is legible and includes appropriate patient identification information, such as complete name and dates of service.
Include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Key Coverage Criteria

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.
(Inferred from references) Iontophoresis for treatment of rheumatoid arthritic knees
(Inferred from references) Transepithelial iontophoresis corneal collagen cross-linking for progressive keratoconus

6 Active Policies

NOVITAS-JH-L34938, Removal of Benign Skin Lesions

NOVITAS-JL-L34938, Removal of Benign Skin Lesions

A57113, Billing and Coding: Removal of Benign Skin Lesions

AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1, Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay

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L81.4, Other melanin hyperpigmentation