Does 15787 require prior authorization?

No, 15787 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 15787?

Medicare facility rate: $14.36. Non-facility rate: $31.40. Work RVU: 0.32.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.32

Facility

$14.36

Non-Facility

$31.40

Documentation of a diagnosis of gender dysphoria or gender incongruence.
Clinical evidence demonstrating marked and sustained incongruence (meeting ≥2 Section A criteria), and documentation demonstrating that the member meets the eligibility criteria in Section B.
If procedures involve fertility preservation, follow policy CP.MP.130 (Fertility Preservation) as applicable.
A signed written statement from a qualified provider recommending gender-affirming medical or surgical treatment.

Chemical peels (known as epidermal peels or chemotherapy of the skin) are consideredmedically necessaryfor active acne.
Medium or deep chemical peels, referred to as dermal peels are consideredmedically necessarywhen there is documented evidence of 10 or more actinic keratoses or other pre-malignant skin lesions that have failed topical retinoid treatment, topical chemotherapeutic agentsandcryotherapy.
Treatment of cutaneous hemangioma, port wine birthmark, or other vascular lesions is consideredmedically necessarywhen there is documented evidence of significant functional impairment (for example, bleeding or a lesion which interferes with vision) and the procedure can be reasonably expected to improve the functional impairment.
Treatment of cutaneous hemangioma, port wine birthmark, or other vascular lesions using lasers or other methods to restore appearance is consideredreconstructivewhen intended to address a significant variation from normal related to a congenital defect.
Dermabrasion (that is, abrasion, salabrasion) is consideredmedically necessaryfor the treatment of actinic keratoses, other pre-malignant skin lesions and localized non-melanoma malignant skin lesions. Examples include, but are not limited to, basal cell carcinoma and carcinoma in-situ.
Permanent removal of hair is consideredmedically necessaryfor recurrent infected cyst, hair follicle infections, or after surgical treatment of pilonidal sinus disease.

AMBETTER-CP.MP.95 — Gender-Affirming Procedures

ANTHEM-MP-A050278 — Last Review Date

BCBSIL-SUR716.001 — Cosmetic and Reconstructive Procedures

BCBSMT-SUR716.001 — Cosmetic and Reconstructive Procedures

BCBSNM-SUR716.001 — Cosmetic and Reconstructive Procedures

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