Community Conversation > Male to female transsexual talk (MTF)

Electrolysis CPT Code

<< < (5/5)

ToriJo:
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.

Mindy More:

--- Quote from: I Am Jess on March 15, 2017, 10:47:45 am ---For me, general electrolysis is excluded as being cosmetic but genital electrolysis was covered as being necessary as a part of GCS.

--- End quote ---

Hi,
I know this is an old post, but I am following all the advice and still striking out.

I just asked Florida Blue about covering CPT 17380 and they said no, it's cosmetic. Of course, I said no it's not costmetic in the case of genital hair electrolysis for SRS, they said it's cosmetic, silly.

They also said the ICD codes don't matter because NO to that CPT.
I've had two sessions with Z's hair removal people, racking up some bills here and looking ahead, I am wanting to square this away asap.
Thanks you whomever can help,
Mindy

Janna:
I got nowhere with calling Blue Shield customer service regarding electrolysis prior auth.  Nobody knew what to tell me even when I asked for a case manager trained in trans services (they said there was no such thing even though someone in another forum said there was).  Finally, I talked to someone from a trans group who gave me contact info for Kelly Sipes, Case Management Lead who was able to get me prior auth for particular electrolysis places and send me a "superbill" form to use to request reimbursement.  So try calling and asking for her by name, or try asking for another case management lead.  Repeated calls may be required as every time I call Blue about anything I get different answers.

Unfortunately, Blue does not consider any electrolygists to be "in network" so they basically don't pay for anything until you reach your max out of pocket for the year, at which point they reimburse 100%.  Instead, they tell you to go to a dermatologist in their network, but I looked into about 30 of them and none offer electrolysis.  A few offer laser hair removal which doesn't help after all the dark hair is gone.  I feel like this situation is just a way for Blue to avoid covering electrolysis and it's part of why I'm returning to Kaiser next year.

Navigation

[0] Message Index

[*] Previous page

Go to full version