What is highmark reimbursement for a shave biopsy

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Forms by Plan Type. Forms by Specialty Type. Forms by Type. Frequently Used Forms. W9 Form-Dental. W9 Form-Medical. Blue Review. Surgical treatment of acne is considered not medically necessary for all other indications not listed above. Internal Medical Policy Committee Revision-Title change, updated criteria with clarifying language; added procedure and diagnosis codes. Fargo Headquarters 13th Ave.

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Enter email Error: Please enter a valid email Subscribe. Treatment of Benign or Premalignant Skin Conditions. Section: Surgery. Effective Date: September 01, Revised Date: November 18, Revision Effective Date: January 02, Last Reviewed: November 29, Applies To: Commercial and Medicaid Expansion. Description Lesions that cause irritation, pain or bleeding may require removal to alleviate symptoms. Criteria Removal of a benign skin lesion e.

Procedure Codes For the treatment of Actinic Keratosis or actinic cheilitis ANY of the following treatments may be considered medically necessary: Cryosurgery with liquid nitrogen ; or Topical medications i. Procedure Codes J J J Diagnosis Codes Covered diagnosis codes for procedure codes , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , A Disclaimer Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered.

Policy ID: S Revised Date: December 09, Revision Effective Date: March 07, Last Reviewed: January 20, For the treatment of Actinic Keratosis AK ANY of the following treatments may be considered medically necessary: Cryosurgery with liquid nitrogen ; or Topical medications i. AK treatments for any other indication is considered cosmetic and, therefore, non-covered.

Biopsy shave is highmark reimbursement for what a humane society in new hampshire

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What is highmark reimbursement for a shave biopsy	W9 Form-Medical. Payment will be subject to the payer's plan language. Diagnosis of malignancies and inflammatory conditions frequently requires numerous biopsies of a higghmark organ or suspicious site. For the following prostate conditions, up to a maximum of sixteen 16 units of shall be considered for reimbursement for the same patient on the same date of filter cummins fuel. Feature Stories.
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Coverage for services may vary for individual members, based on the terms of the benefit contract. Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania.

Quick Links: Manuals. Highmark Provider Manual. Medical Policy Medical Policy. Medical Policies. Medicare Advantage Medical Policies. Requiring Authorization. Barbieri is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number TAR and receives partial salary support through a Pfizer fellowship grant to the Trustees of the University of Pennsylvania. Hartman is supported by an American Skin Association research grant Correspondence: Rebecca I.

In , the 2 Current Procedural Terminology CPT codes for skin biopsies were replaced with 6 new CPT codes to allow for technique specification and differential reimbursement. We sought to evaluate whether the concurrent decrease in reimbursement for shave biopsies and increase in reimbursement for punch biopsies led to utilization changes.

We examined shave and punch biopsies submitted for pathologic examination at 3 academic centers in May and May Totals included 11, Our results demonstrate small yet important changes in biopsy use patterns within the context of recent reimbursement changes when analyzing academic and private practices separately. Although small in magnitude, this change in behavior may have a substantial impact when extrapolated to behavior across the nation.

In , the 2 Current Procedural Terminology CPT codes for skin biopsies and were replaced with 6 new CPT codes that specify biopsy technique and associated procedural complexity. We included shave and punch biopsies of skin performed by physician dermatologists and mid-level providers ie, physician assistants, nurse practitioners at dermatology practices.

All biopsies performed by a technique other than shave or punch, unspecified biopsy type, consultation cases, nonskin biopsies eg, mucosa , and biopsies performed at nondermatology practices were excluded. We also excluded biopsies by providers who were not present during both study periods to account for provider mix. Because care practices may differ between private and academic settings as well as between physicians and mid-level providers, we performed subgroup analyses by practice setting and provider type.

We identified 11, biopsies The overall use of punch biopsies relative to shave biopsies did not change between the years. Provider type was not associated with differing utilization of biopsy type. Overall, there was not a considerable shift in utilization behavior from shave to punch biopsies after the introduction of new coding changes. However, our study does demonstrate a small yet significant increase in punch biopsy utilization among private practices, and a decrease among academic practices.

Although the change in biopsy utilization behavior is small in magnitude, it may have a substantial impact when extrapolated to behavior across the entire United States.