Author Topic: Electrolysis CPT Code  (Read 10047 times)

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Offline sarahla

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Electrolysis CPT Code
« on: January 24, 2017, 05:18:14 pm »
Does anyone know what the CPT code (U.S.) is for electrolysis for M2F gender reassignment surgery?

I am going through the pre-authorization process.

Offline jfong

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Re: Electrolysis CPT Code
« Reply #1 on: January 24, 2017, 05:19:57 pm »
Try 17380

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« Last Edit: June 30, 2018, 01:11:21 pm by Laurie »

Offline sarahla

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Re: Electrolysis CPT Code
« Reply #2 on: January 24, 2017, 06:04:12 pm »
Thanks!

I did a reverse Google lookup on the code you provided and see this http://bioportal.bioontology.org/ontologies/CPT?p=classes&conceptid=17380, among others.

The code is:

Surgery | Surgical Procedures on the Integumentary System | Other Procedures on the Integumentary System | Electrolysis epilation

I had to look up the word Integumentary System. In laywoman's term, the translation is "skin". That means that 17380 means "electrolysis on the skin". Surgery, well, spraying liquid nitrogen on the skin is a surgery. By this definition, I can submit a 17380 for electrolysis on hair on my back, thighs, face, or anywhere else.

There is nothing in the 17380 CPT code that says "GRS".

Since insurance companies do not pay for electrolysis as a general rule, but do pay for electrolysis with respect to GRS, what will tell the insurance company, Blue Shield of California in this case, that 17380 is for GRS? Since my physician wants only a single code and the form presumably does not have a space to write explanations, what keys the insurance company into GRS?

Is the CPT code used possibly with an ICD code 302.85 (gender dysphoria), although even there that does not say "genital electrolysis in preparation for gender reassignment surgery in M2F individuals".

Offline sarahla

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Re: Electrolysis CPT Code
« Reply #3 on: January 25, 2017, 09:26:55 am »
I PAINED with my electrologists last night, but got the information that I wanted. By the way, nothing says masochist like having 2 electrologists working on your back at the same time, one with the blend and the other with thermolosis, each trying to outdo the other for an hour, really 90 minutes.

Anyways:

The CPT code, 17380, provided in this posts answer is correct.

The pre-authorization must also include 2 ICD (ICD-9-CM) codes

308.25 Gender role disorder
V.49.89 Transgender

Somehow through magic the insurance company will know that "electrolysis for transgender patients" means electrolysis for GCS/SRS.

Thanks! Now off to Blue Shield.

Offline I Am Jess

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Re: Electrolysis CPT Code
« Reply #4 on: January 25, 2017, 10:03:33 am »
I don't remember which code I used when I submitted my electrolysis reimbursement request but I got a response back saying that my lady was not an approved provider. I had to appeal the denial and when they took to long I appealed to my states insurance regulators. I have Anthem Blue Cross. I finally got my reimbursement.

Offline Artesia

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Re: Electrolysis CPT Code
« Reply #5 on: January 25, 2017, 05:13:55 pm »
My Anthem Blue Cross auto declines it :(
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Michelle_P

Re: Electrolysis CPT Code
« Reply #6 on: January 25, 2017, 05:34:32 pm »
I'm pretty sure most insurers auto-decline EVERYTHING. Did you know that the actual job title of the nice person that processes your claim is "loss mitigation specialist?"

With insurers it pays to develop a tough skin and immediately re-file a denied claim. There is a state agency for insurance companies that usually has a customer grievance or advocacy office (unless totally in the insurers pocket), and if the re-filed claim gets denied, file a complaint and snail mail a copy of the complaint and denied claim to the corporate VP running the
Medical Insurance unit. They often have a "make it go away" desk.

Always keep copies of the claims and rejections. I scan them into a computer and generate hard copies as needed. Each piece of correspondence gets all the older filings, letters and rejections attached to it for their convenience and a not so subtle reminder that you do have a record and are being diligent.

Oh, and be diligent about this.

Trust me, being obnoxiously persistent pays off. It's how I roll.


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Offline Maybebaby56

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Re: Electrolysis CPT Code
« Reply #7 on: January 25, 2017, 06:23:58 pm »
The CPT code, 17380, provided in this posts answer is correct.

The pre-authorization must also include 2 ICD (ICD-9-CM) codes

308.25 Gender role disorder
V.49.89 Transgender

Somehow through magic the insurance company will know that "electrolysis for transgender patients" means electrolysis for GCS/SRS.

Thanks! Now off to Blue Shield.

Thank you for this, Sarah. You prompted me to contact my insurer (Aetna) for the $$$ I have spent on genital electrolysis.

Small note:  The 2016 ICD-9-CM code for gender identity "disorder" is 302.85, not 308.25.  The 2017 ICD-10-CM code is now F64.0. The "V.49.89 Transgender" I couldn't find anywhere.  Can you help?

I'm pretty sure most insurers auto-decline EVERYTHING. Did you know that the actual job title of the nice person that processes your claim is "loss mitigation specialist?"

With insurers it pays to develop a tough skin and immediately re-file a denied claim. There is a state agency for insurance companies that usually has a customer grievance or advocacy office (unless totally in the insurers pocket), and if the re-filed claim gets denied, file a complaint and snail mail a copy of the complaint and denied claim to the corporate VP running the Medical Insurance unit. They often have a "make it go away" desk.

Always keep copies of the claims and rejections. I scan them into a computer and generate hard copies as needed. Each piece of correspondence gets all the older filings, letters and rejections attached to it for their convenience and a not so subtle reminder that you do have a record and are being diligent.

Oh, and be diligent about this.

Trust me, being obnoxiously persistent pays off. It's how I roll.

Great advice, Michelle. You're a smart girl!

~Terri

"How we spend our days is, of course, how we spend our lives" - Annie Dillard

Offline sarahla

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Re: Electrolysis CPT Code
« Reply #8 on: January 25, 2017, 06:34:06 pm »
Thank you.

(A slightly off topic, but is there a way to get notified of a response to a post that I either created or a reply to a post that I made on someone else's topic? Right now I have to come back to the page and refresh the page to see if any updates. That is a bit annoying.)

Offline Dena

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Re: Electrolysis CPT Code
« Reply #9 on: January 25, 2017, 06:56:53 pm »
Not sure this is the answer you are after but on the top left of the screen there is "Show new replies to your posts" which will tell you of threads you posted to that have been active after that. Unfortunately the box on the right takes you to the last post in the thread. You have to backup in the thread until you find your post then work your way forward. The recent topics list works differently in that the box on the right gives you unread posts.
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Offline Artesia

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Re: Electrolysis CPT Code
« Reply #10 on: March 14, 2017, 06:22:31 am »
I was wondering if there was a way to get the face done?  I can't afford it by myself, and am not planning on surgery at the moment, but I want the facial hair gone, it's my biggest hate on my own face.  Shaving just doesn't cut it, well it cut's it, it just doesn't make me feel better as I can still see it.  stupid beard.
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Offline AlyssaJ

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Re: Electrolysis CPT Code
« Reply #11 on: March 14, 2017, 06:34:29 am »
Just out of curiosity, did your insurance tell you they cover electrolysis?  I ask only because I too have a plan through Anthem BCBS and the Gender Reassignment Services policy they sent me specifically listed Hair Removal by Electrolysis, Laser or Wax/Transplant as a cosmetic service not covered.  I'm just curious if you have better coverage than I do or if you found a way around this limitation.

Offline Artesia

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Re: Electrolysis CPT Code
« Reply #12 on: March 14, 2017, 07:48:23 pm »
Just out of curiosity, did your insurance tell you they cover electrolysis?  I ask only because I too have a plan through Anthem BCBS and the Gender Reassignment Services policy they sent me specifically listed Hair Removal by Electrolysis, Laser or Wax/Transplant as a cosmetic service not covered.  I'm just curious if you have better coverage than I do or if you found a way around this limitation.

Depends on the plan.  My company sets the plan, and chooses the options allowed.  Mine used to not allow it, and then did allow it, and now I'm not so sure anymore.
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Offline I Am Jess

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Re: Electrolysis CPT Code
« Reply #13 on: March 15, 2017, 10:47:45 am »
Just out of curiosity, did your insurance tell you they cover electrolysis?  I ask only because I too have a plan through Anthem BCBS and the Gender Reassignment Services policy they sent me specifically listed Hair Removal by Electrolysis, Laser or Wax/Transplant as a cosmetic service not covered.  I'm just curious if you have better coverage than I do or if you found a way around this limitation.

For me, general electrolysis is excluded as being cosmetic but genital electrolysis was covered as being necessary as a part of GCS. 

Offline RavenMoon

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Re: Electrolysis CPT Code
« Reply #14 on: March 15, 2017, 11:35:10 am »
Surgery, well, spraying liquid nitrogen on the skin is a surgery.

Who sprays liquid nitrogen on their skin???
 That would freeze it so badly you would kill the tissue.

That's not what electrolysis is.


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Offline Yumistar

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Re: Electrolysis CPT Code
« Reply #15 on: January 23, 2018, 05:08:16 pm »
Ok so after a lot of time and struggle being on phone with Insurance and provider I have found the following codes that need to be sent in with a predetermination form CPT - 17380 along with ICD-10-CM F64.8 & F64.9 I will update and let you all know if this works and I get approved or not.
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Re: Electrolysis CPT Code
« Reply #16 on: June 29, 2018, 04:15:34 pm »
Ok so after a lot of time and struggle being on phone with Insurance and provider I have found the following codes that need to be sent in with a predetermination form CPT - 17380 along with ICD-10-CM F64.8 & F64.9 I will update and let you all know if this works and I get approved or not.

CPT-17380 & Diagnosis Code F64.9 worked for my insurance claim and they reimbursed me.  :)
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Offline Janna

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Re: Electrolysis CPT Code
« Reply #17 on: December 03, 2020, 09:41:03 pm »
With Blue Shield PPO of California, how exactly do you get prior authorization for electrolysis?  A lot of people here say they submitted a claim for reimbursement and then sometimes fought denials, but isn't prior auth what insurance really wants you to do?

I sent a message to Blue Shield member services and they sent a response including "Please have your prescribing doctor call 800-541-6652 to request for prior authorization."  But what doctor needs to do this?  A dermatologist?  Electrologist?  Primary care physician?

And what info must they include to prove it medically necessary?  I feel like many docs would just be confused.

Offline Janna

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Re: Electrolysis CPT Code
« Reply #18 on: December 05, 2020, 11:32:38 am »
I think I found my answer over at trans health project.  In the trans health insurance tutorial section under applying for coverage, they say you first must gather one or two letters from therapists describing how you fit the insurance company's definition of medically necessary treatment.  You may also need and one from your endocrinologist saying how long you've been on hormones.  I think at this point most insurance follows the WPATH 6 or 7 guidelines for these requirements, which you can look up, though it's better to find the actual insurance company interpretation of what is required for each procedure.

They then explain that using your letters and the correct procedure codes, you can get a doctor to request prior auth or you can submit the request yourself.  You can also pay out of pocket and get reimbursed later but there is sometimes a penalty for doing that such as insurance paying $500 less.  It also looks like you can't submit a prior auth request until your insurance coverage starts (I'm starting new insurance Jan 1st and wanted to get a request submitted early but I don't think it's possible).

Since prior auth request can be submitted by any doctor or by myself, it seems the type of doctor is not as important as finding a doctor that is willing to do the work and knows the right codes and the right info to submit.  If you want to do it yourself, you have to call the insurance and get them to tell you what forms are required and where to mail them to.  Only a request in writing will get you an official response, which will often be a denial which you must appeal, as mentioned by others in this thread.

If you live in California, you can appeal it up to the level of a state overseer who will almost always decide in your favor.  The transgender law center has a guide on the process and describes how to appeal to the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).

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Re: Electrolysis CPT Code
« Reply #19 on: December 05, 2020, 12:45:35 pm »
... I think at this point most insurance follows the WPATH 6 or 7 guidelines for these requirements, which you can look up,  ...

We keep the WPATH Standards of Care version 7 here for our members to access.  :)

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