Does L95.1 require prior authorization?

No, L95.1 does not require prior authorization (high confidence). Covered without prior authorization.

`L95.1`, Erythema elevatum diutinum

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This policy provides billing, coding, and guideline information that complements the Local Coverage Determination (LCD) 'Cosmetic and Reconstructive Surgery' L33428; the full policy content is not included here, so specific documentation requirements (e.g., medical records, prior authorizations, forms) are not available in the provided excerpt.
Documentation supporting the claim must be maintained in the medical record and be available to Medicare upon request.
Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and reasons for the service; claims without ICD-10-CM codes will be returned.
For diagnostic tests related to the service, report the test result if known; if the result is not known, report the signs or symptoms that prompted the test.

Follow the related Local Coverage Determination (LCD) for clinical indications and medical necessity criteria for reduction mammaplasty.
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.
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.

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J15-L39506, Cosmetic and Reconstructive Surgery

J15

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J18-L39506, Cosmetic and Reconstructive Surgery

J18

CGS-J18-L34200

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