Does R52 require prior authorization?

No, R52 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`R52`, Pain, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
Medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
The office visit record or operative report must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
Claims must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and the reason(s) for the service.

Key Coverage Criteria

No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
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).
Removal is covered when documented objective changes (e.g., increase in size) support a diagnosis warranting excision.
Removal of a benign lesion is covered when the treating physician documents medical necessity for removal (physician judgment that lesion merits removal).
Report histopathologic examination separately when performed using CPT codes 88304-88305.

20 Active Policies

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J18-L34200, Removal of Benign Skin Lesions

J18

A59915, Billing and Coding: Pharmacogenomic Testing

NGS-J6-L39995, Pharmacogenomic Testing

A58812, Billing and Coding: Pharmacogenomics Testing

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R52, Pain, unspecified