Does 12054 require prior authorization?

No, 12054 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 12054?

Medicare facility rate: $197.07. Non-facility rate: $391.46. Work RVU: 3.41.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.41

Facility

$197.07

Non-Facility

$391.46

Treatment of a keloid is consideredmedicallynecessarywhen both of the following are present:
There is documented evidence of significant functional impairment related to the keloid;and
The treatment can be reasonably expected to improve the functional impairment.
Treatment of a keloid with radiation therapy (up to 3 fractions) is consideredmedically necessaryas adjunct therapy following surgical excision (initiated within 3 days) when the medically necessary criteria for keloid removal are met.
Treatment of a keloid isreconstructivewhen the keloid results in a significant variation from normal related to accidental injury, disease, trauma, or treatment of a disease.
Treatment of a keloid with radiation therapy (up to 3 fractions) is consideredmedically necessaryas adjunct therapy following surgical excision (initiated within 3 days) when the reconstructive criteria for keloid removal are met.

ANTHEM-CG-SURG-31 — CG-SURG-31 Treatment of Keloids and Scar Revision

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