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.
• Priority Health Medicare plans

Definition

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

Medical policy

• Skin Conditions - 91456

Excisions coverage

All excisions may be covered at non-standard cost-sharing levels.

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.