Does L98.499 require prior authorization?

No, L98.499 does not require prior authorization (high confidence). Covered without prior authorization.

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`L98.499`, Non-pressure chronic ulcer of skin of other sites with unspecified severity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The CPB does not state specific, detailed documentation requirements; it indicates that CPT/ICD-10 codes are covered "if selection criteria are met." No explicit required medical record elements, prior-authorization items, or exact documentation checklists are provided in this document.
Documentation of failure to respond to appropriate conservative therapies (examples provided: rest, ice application, and medications).
Medical record evidence supporting that selection criteria were met prior to billing code 0101T (i.e., clinical notes, prior treatment attempts, imaging reports specifying deposit size and location).

If claiming coverage under the CPB, supporting clinical documentation must link the ICD-10 diagnosis to the policy-covered indication (i.e., calcific tendinopathy of shoulder meeting the above criteria) and should avoid coding that the policy explicitly lists as not covered (e.g., subacromial impingement syndrome).

None specified in this document. The text summarizes clinical studies and systematic reviews but does not provide insurer coverage documentation requirements (no required clinical notes, imaging, prior conservative therapy documentation, or ICD-10/CPT code lists are given in this excerpt).

Key Coverage Criteria

Medicinal leech therapy is medically necessary for salvage of vascularly compromised flaps (muscle, skin, and fat tissue surgically removed from one part of body to another).
Medicinal leech (Hirudo medicinalis) therapy is medically necessary for any of the following conditions: poor venous drainage (venous congestion/venous outflow obstruction).
Medicinal leech therapy is medically necessary for salvage of vascularly compromised replants (limbs or other body parts re-attached after traumatic amputation).
Medical maggots (larval therapy) are medically necessary for debridement of non-healing necrotic skin and soft tissue wounds including chronic diabetic foot ulcers.
Medical maggots are medically necessary for debridement of neuropathic foot ulcers.
Medical maggots are medically necessary for debridement of non-healing traumatic or post-surgical wounds.

6 Active Policies

ANTHEM-CG-MED-73, Hyperbaric Oxygen Therapy (Systemic/Topical)

AMBETTER-CP.MP.109, Panniculectomy

AETNA-CPB-0556, Bio-Surgery: Medicinal Leech Therapy and Medical Maggots

AETNA-CPB-0587, Pancreas Kidney Transplantation

AETNA-CPB-0649, Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

`L98.499`, Non-pressure chronic ulcer of skin of other sites with unspecified severity

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

L98.499, Non-pressure chronic ulcer of skin of other sites with unspecified severity

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`L98.499`, Non-pressure chronic ulcer of skin of other sites with unspecified severity