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ICD-10-CM L94.9, Localized connective tissue disorder, unspecified | No Prior Auth

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`L94.9`, Localized connective tissue disorder, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Clinical records must clearly document medical necessity and an explicit rationale for why removal is not cosmetic when billing CPT 17106-17108.
Coding and billing guidance must be used with the associated Local Coverage Determination; coverage details for CPT 11055-11057 are delineated in the Medicare Internet-Only Manual and should be followed for claims.

Key Coverage Criteria

Removal of benign skin lesions billed with CPT 17106, 17107, or 17108 is covered only when clinical records document medical necessity and explicitly state why the procedure is not cosmetic.
Treatment of hyperkeratotic lesions (e.g., corns and calluses) billed with CPT 11055, 11056, or 11057 is covered as described in the Medicare Internet-Only Manual.

1 Active Policy

A57161, Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

Related Codes

11201(1 policies)11300(1 policies)11301(1 policies)11302(1 policies)11303(1 policies)11305(1 policies)11306(1 policies)11200(1 policies)

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