Port wine stain/hemangioma treatment
Priority Health Medicare plans follow Medicare authorization and billing rules.
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.
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.
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
Port wine stain/hemangioma treatment billing
See the medical policy for codes that may apply and codes not covered.