Scar revisions/keloid scar treatment

Applies to:

All plans

Note: Priority Health Medicare plan coverage is determined by the Centers for Medicare and Medicaid Services (CMS); if a coverage determination has not been adopted by CMS, our medical policy applies

Definition

Scar revision by reconstructive surgery, including microsurgery, focuses on undoing or masking the destructive effects of trauma, surgery or disease. It is performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.

Medical policy

Scar revision coverage

Repair of facial injuries can often times result in significant scarring that is cosmetically unacceptable. Since traumatic facial injuries are often repaired under suboptimal conditions, Priority Health will cover one revision of facial scars. Member copays and coinsurance will apply. Coverage is limited to one revision only. See the criteria in the medical policy.

When surgical treatment is covered, some members will have non-standard cost-sharing for those services.

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.

Scar revision/keloid treatment authorizations

Not required.

Scar revision/keloid treatment billing

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