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Navigating insurance for neurofibroma removal can feel overwhelming, but understanding the process can make a significant difference. With the right information and documentation from your doctor, most insurance plans should cover the procedure.
Why Neurofibroma Removal is Medically Necessary
Neurofibromas are not simply cosmetic issues. Their removal is often medically justified for several important reasons, which your doctor can help document for your insurance provider.
What to Do If Your Claim is Denied
A claim denial is often due to how the medical evaluation was documented. Insurance companies need to understand that neurofibromas are not typical benign tumors like skin tags. If you’re denied, here are the steps you can take:
- Check with your doctor’s office: Ensure they properly documented your symptoms, disfigurement, reliance on medication, and any psychosocial stress. They may need to file an addendum to their original notes.
- Request a reconsideration: You or your doctor can ask the insurance company to reconsider, stressing the medical reasons why the treatment is necessary.
- Contact your State Health Insurance Commissioner: If you face another denial from a private insurer, this is a good next step.
- Notify your employer: If your insurance is through your job, let your company’s benefits coordinator know about the denials.
For those covered by Medicaid or Medicare, the treatment should be covered. A denial is typically due to a lack of documentation, and you can follow the same steps listed above.
Insurance Billing and Diagnosis Codes
Both a diagnosis code and a billing code must be on the insurance claim form. Here are the codes that are commonly used for neurofibromatosis.
Diagnosis (ICD-10) Codes
| Code | Description |
|---|---|
| Q85.00 | NF unspecified |
| Q85.01 | NF1 |
| Q85.02 | NF2 |
Billing (CPT) Codes
| Code | Description |
|---|---|
| 17110 | Destruction of up to 14 lesions using techniques like laser surgery, electrosurgery, cryosurgery, etc. |
| 17111 | Destruction of 15 or more lesions using the techniques listed above. |
| 64788 | Excision of neurofibromas using a scalpel. |
| 64790 | Excision from a peripheral nerve. |
| 64792 | Excision of extensive neurofibroma (including malignant type). |
| 0419T | Destruction of extensive (greater than 50) neurofibromas of the face, head, and neck. |
| 0420T | Destruction of extensive (greater than 100) neurofibromas of the trunk and extremities. |