Does R23.9 require prior authorization?

No, R23.9 does not require prior authorization (high confidence). Covered without prior authorization.

`R23.9`, Unspecified skin changes

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Supportive documentation evidencing the condition and treatment must be documented in the medical record and be available to the Contractor upon request.
ICD-10-CM diagnosis codes supporting the medical necessity of the service must be submitted with each claim.
High-utilization or repeat testing should include clinical justification in the record (for example, repeat testing due to unsatisfactory response to treatment) to support medical necessity.
No specific documentation requirements, prior authorization, or required medical records/test results are specified in this policy bulletin.

Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).
Exceeding the stated testing parameters may be covered when preliminary testing failed and immunotherapy failed to control symptoms, provided documentation supports medical necessity.
None — Aetna considers Grenz ray therapy experimental and investigational for the treatment of dermatologic conditions because there is inadequate evidence in the published peer-reviewed medical literature regarding the effectiveness of Grenz ray therapy in the treatment of skin disorders.
Thyroid function testing is consideredmedically necessaryfor individuals who meet any of the following indications:

ANTHEM-CG-LAB-20, Thyroid Testing

AETNA-CPB-0231, Grenz Ray Therapy for Skin Disorders

A57181, Billing and Coding: Allergy Testing

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