15819
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Preoperative photographs demonstrating the redundant or excessive skin.
- Documentation of a functional deficit due to severe physical deformity or disfigurement from redundant/excessive skin.
- Documentation that the surgery is expected to restore or improve the documented functional deficit.
- Documentation that the redundant or excessive skin is interfering with activities of daily living.
Key Coverage Criteria
- Rhytidectomy, or procedures for excision of redundant or excessive skin of other anatomical areas (e.g., neck, upper and lower extremities, buttocks), is considered medically necessary when ALL of the following criteria are met: There is presence of a functional deficit due to a severe physical deformity or disfigurement resulting from the redundant or excessive skin.
- Rhytidectomy, or procedures for excision of redundant or excessive skin of other anatomical areas, is considered medically necessary when ALL of the following criteria are met: The surgery is expected to restore or improve the functional deficit.
- Rhytidectomy, or procedures for excision of redundant or excessive skin of other anatomical areas, is considered medically necessary when ALL of the following criteria are met: The redundant or excessive skin is demonstrated on preoperative photographs.
- Rhytidectomy, or procedures for excision of redundant or excessive skin of other anatomical areas, is considered medically necessary when ALL of the following criteria are met: The redundant or excessive skin is interfering with activities of daily living.
- For areas other than the face: Evidence, including photographs, that the redundant or excessive skin is causing persistent intertriginous dermatitis, cellulitis, or skin ulceration, which is refractory to at least three (3) months of medical management, including all applicable treatments (in addition to good hygiene practices, applicable treatment should include topical antifungals; topical and/or systemic corticosteroids; and/or local or systemic antibiotics).
- Rhytidectomy (facial area) or other redundant skin excision to correct functional impairment due to facial paralysis or palsy (e.g., difficulty with eating, swallowing and achieving oral continence) — rare situations where procedure may be medically necessary to correct functional impairment.
3 Active Policies
CIGNA-0470 — Redundant Skin Surgery - (0470)
ANTHEM-MP-A050276 — ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck
REGENCE-SUR12 — Cosmetic and Reconstructive Procedures
Related Codes
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