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Managed Care Help

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The following are Managed Care Prior Authorization Requirements for onychomycosis:

Onychomycosis (tinea unguium; ICD-9 code 110.1) is a general infection of the nail unit caused by fungal microorganisms, with dermatophytes being responsible for more than 90% of reported cases in the United States.

Managed care organizations may require one or more of the following conditions to ensure the reimbursement of therapy for onychomycosis:

Bullet pain of foot/limb (729.5)
Bullet paronychia of toe (681.11)
Bullet paronychia of finger (681.02)
Bullet peripheral vascular disease or claudication (443.9)
Bullet difficulty walking (719.77)
Bullet dystrophic nail or onycholysis (703.8)

Please see specific guidelines of individual managed care plans.


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