Does 15221 require prior authorization?

No, 15221 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 15221?

Medicare facility rate: $57.78. Non-facility rate: $133.94. Work RVU: 1.16.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.16

Facility

$57.78

Non-Facility

$133.94

Documentation of attempted conservative therapy and evidence of its failure when required (or justification that conservative therapy is not standard of care or is contraindicated).
For skin tag removal: documentation of anatomical location (affecting eyesight or area of friction) and evidence of repeated irritation and bleeding.
For scar/keloid revision: documentation of pain unresponsive to conservative therapy, recurrent infection, unstable or friable tissue, or objective functional impairment.
Photographs may be requested, if applicable.

Reconstructive surgery for abnormal structures caused by congenital defects
Reconstructive surgery for abnormal structures due to developmental abnormalities
Reconstructive surgery following previous or concurrent surgeries
Reconstructive surgery to correct defects from trauma
Reconstructive surgery to repair damage from infection
Reconstructive surgery for defects caused by tumors

AMBETTER-CP.MP.31 — Cosmetic and Reconstructive Procedures

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