Author Topic: Electrolysis CPT Code  (Read 7848 times)

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Offline ToriJo

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Re: Electrolysis CPT Code
« Reply #20 on: December 06, 2020, 09:29:37 am »
For any medical procedure, insurance needs two things to determine coverage: diagnosis code and procedure code.

The diagnosis code is the "WHY?"  The Procedure code is the "WHAT?"

I've had the electrologist use F64.1 for the diagnosis code, and 17380 for the procedure code. I've also used a modifier to 17380 when there were more than a few hours in one session.

Note that 17380 is billed in "units" of 30 minutes.  I've had one insurance that insisted the invoice include the number of "units" (basically hours multiplied by 2).  I had my electrologist add a column entitled "30 minute units" to her invoice.

That said, most insurance doesn't cover most electrolysis.  So the codes won't work magic in those cases.  But if you do have coverage, I hope this helps.  Also, if you do have coverage, and there is no in-network electrolysis (there almost certainly is not), ask for an out-of-network gap exception.  Basically if approved this lets you treat your electrologist as if they are in-network as far as deductibles and the like.  But you have to ask for it.  Note the one thing it doesn't guarantee if you get it is the maximum reimbursement rate (I.E. how much they'll pay).  I've also had to argue with insurance who have picked absurdly low reimbursement rates.