Prior Auth Required

11451 - An example of a procedure-to-procedure edit would be if procedure codes (i.e., removal of a sweat gland lesion) and

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceAn example of a procedure-to-procedure edit would be if procedure codes (i.e., removal of a sweat gland lesion) and
Procedure / Service Description

Procedure-to-procedure detail edits define pairs of CPT or HCPCS codes that should not be reported together on the same - detail was denied due to NCCI. An example of a procedure-to-procedure edit would be if procedure codes 11451 (i.e., removal of a sweat gland lesion) and 93000 (i.e., electrocardiogram) were billed on the same claim for the same DOS. Procedure code 11451 describes a more complex service than procedure code 93000, and therefore, the secondary procedure would be denied.

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.