61559
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
33.17
Facility
$2343.74
Non-Facility
$2343.74
Documentation Required
- 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.
Key Coverage Criteria
- 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
1 Active Policy
AMBETTER-CP.MP.31 — Cosmetic and Reconstructive Procedures
Related Codes
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