Define Medical necessity: Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service ...
Before admitting a member to a hospital for elective (non-obstetrical, non-life threatening) inpatient care, medical information will need to be supplied to BCBSKS in order to certify medical necessity. A length of stay will be assigned at the time of pre-certification and will be subject to...
hemangioma, hypertrophic scars, superficial basal cell carcinoma, and Bowen's disease. The authors concluded that IPL was an effective treatment modality for a growing range of dermatologic disease and in some cases may represent a treatment of choice. It is typically well-tolerated. Moreover, thes...
Breast augmentation (breast implants and pectoral implants) - for medical necessity criteria for breast reconstruction, see CPB 0185 - Breast Reconstructive Surgery; see also CPB 0142 - Breast Implant Removal; for medical necessity criteria for augmentation mammoplasty to treat gender dysphoria, see CPB...