Port wine stain/hemangioma treatment

Applies to:

All plans

Priority Health Medicare plans follow Medicare authorization and billing rules.

Definition

A port-wine stain (nevus flammeus) is a discoloration of the skin caused by a vascular anomaly (a capillary malformation in the skin). A hemangioma is a benign tumor that occurs in the endothelial lining of the blood vessels, usually developing within the first few weeks of life.

Medical policy

Cosmetic and Reconstructive Surgery Procedures - 91535

Port wine stain/hemangioma treatment coverage

For commercial group and individual plans, and usually for employer group Medicare plans, treatment is covered only when necessary due to functional impairment. See the criteria in the medical policy, above.

When these surgeries meet coverage criteria, they're covered at non-standard cost sharing.

Non-standard cost-sharing

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

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

Port wine stain/hemangioma treatment authorizations

Not required.

Port wine stain/hemangioma treatment billing

See the medical policy for codes that may apply and codes not covered.