Excisions: Removal of lipomas, sebhorrheic keratoses, skin tags

Applies to:

  • Commercial group HMO, EPO, POS and PPO plans
  • Commercial individual MyPriority® plans
  • Priority Health Choice plans (Medicaid and Healthy Michigan Plan) - Some treatments are excluded from coverage, reference the certificate of coverage in the member handbook.
  • Priority Health Medicare plans

Definition

Surgical excision of lipomas, sebhorrheic keratoses, and skin tags, as defined by the CPT codes below.

Excisions coverage

All excisions may be covered at non-standard cost-sharing levels. See below the diagnosis codes for more information on non-standard cost-sharing.

Lipomas: All surgical services (CPT codes 10000-69999) billed with these diagnoses:

  • D170-D17.39, D17.9, benign lipomatous neoplasm of skin and subcutaneous tissue

Sebhorrheic keratoses: All surgical services (CPT codes 10000-69999) billed with these diagnoses:

  • L82.0, inflamed seborrheic keratosis
  • L82.1, other seborrheic keratosis

All procedures for these diagnoses not covered for Medicaid 

Skin tags:

  • 11200, removal of skin tags, multiple fibrocutaneous tags, any area: up to and including 15 lesions
  • 11201, removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions (list separately in addition to code for primary procedure)

Non-standard cost-sharing

If/when commercial employer group and MyPriority® individual plans cover certain surgeries, these surgeries may be covered at a different cost-sharing level than our standard benefit coverage levels.

To verify member cost sharing and coverage, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.