Does L98.0 require prior authorization?

No, L98.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L98.0`, Pyogenic granuloma

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
The patient’s medical record must include the ordering provider’s assessment as it relates to the patient’s complaint for that visit.

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.
A valid ICD-10-CM diagnosis code that best describes the patient’s condition for which the debridement service was performed must be reported on the claim.
When a service requires a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Excision of a benign skin lesion is covered when there is clinical suspicion of malignancy (e.g., ICD-10-CM D48.5) documented in the medical record.
Removal is covered to address disturbance of skin sensation when documented (ICD-10-CM R20.0-R20.3, R20.8).

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L34032, Debridement Services

J18

CGS-J18-L34200, Removal of Benign Skin Lesions

J18

A57482, Billing and Coding: Removal of Benign Skin Lesions

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