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12465 Results

Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm

Service Code
11626 (CPT) Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less

Service Code
11640 (CPT) Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm

Service Code
11641 (CPT) Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm

Service Code
11642 (CPT) Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm

Service Code
11643 (CPT) Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm

Service Code
11644 (CPT) Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm

Service Code
11646 (CPT) Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Medically Necessary Routine Foot Care

Service Code
11719 (CPT) Trimming of nondystrophic nails, any number
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Medically necessary routine foot care is the cutting or removal of corns and calluses; trimming, cutting, clipping, or debriding of nails; and other hygienic care due to a physical or clinical finding that is consistent with a metabolic, neurological, and/or peripheral vascular disease diagnosis and indicative of severe peripheral involvement.

Place of Service

Inpatient, Outpatient, Office.

Other Information

Modifiers: Q7, Q8, Q9

How to Submit

N/A - No authorization is required

Resources

Medically Necessary Routine Foot Care

Service Code
11720 (CPT) Debridement of nail(s) by any method(s); 1 to 5
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Medically necessary routine foot care is the cutting or removal of corns and calluses; trimming, cutting, clipping, or debriding of nails; and other hygienic care due to a physical or clinical finding that is consistent with a metabolic, neurological, and/or peripheral vascular disease diagnosis and indicative of severe peripheral involvement.

Place of Service

Inpatient, Outpatient, Office.

Other Information

Modifiers: Q7, Q8, Q9

How to Submit

N/A - No authorization is required

Resources

Medically Necessary Routine Foot Care

Service Code
11721 (CPT) Debridement of nail(s) by any method(s); 6 or more
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Medically necessary routine foot care is the cutting or removal of corns and calluses; trimming, cutting, clipping, or debriding of nails; and other hygienic care due to a physical or clinical finding that is consistent with a metabolic, neurological, and/or peripheral vascular disease diagnosis and indicative of severe peripheral involvement.

Place of Service

Inpatient, Outpatient, Office.

Other Information

Modifiers: Q7, Q8, Q9

How to Submit

N/A - No authorization is required

Resources

Avulsion of nail plate, partial or complete, simple; single

Service Code
11730 (CPT) Avulsion of nail plate, partial or complete, simple; single
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)

Service Code
11732 (CPT) Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Evacuation of subungual hematoma

Service Code
11740 (CPT) Evacuation of subungual hematoma
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;

Service Code
11750 (CPT) Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)

Service Code
11755 (CPT) Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Repair of nail bed

Service Code
11760 (CPT) Repair of nail bed
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Reconstruction of nail bed with graft

Service Code
11762 (CPT) Reconstruction of nail bed with graft
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Wedge excision of skin of nail fold (eg, for ingrown toenail)

Service Code
11765 (CPT) Wedge excision of skin of nail fold (eg, for ingrown toenail)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of pilonidal cyst or sinus; simple

Service Code
11770 (CPT) Excision of pilonidal cyst or sinus; simple
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Excision of pilonidal cyst or sinus; extensive

Service Code
11771 (CPT) Excision of pilonidal cyst or sinus; extensive
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required