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How Can I Get Cpt 15830 Approved in Addition to Already Approved 15847 for Functional Repair?

I have consulted with 3 plastic surgeons and 2 general surgeons regarding a diastasis repair w/umbilical hernia related to pregnancy. General surgery cannot do the diastasis repair; refering me to the plastic surgeons. The plastic surgeons need the insurance to prior auth for a pannulectomy in order to do the surgery.The diastasis repair has been approved but after letters from my primary doctors and surgeons 15830 is still denied after a 2nd level appeal. Any suggestions greatly appreciated!

Doctor Answers (1)

Insurance for Diastasis, hernia, tummy tuck

+1

Without a photo, and without knowing that you have an overhanging pannus, which you haven't told us in your question, it is hard to begin to answer the question.

  • Usually, hernias are covered by insurance. They commonly have symptoms, and unrepaired have known complications
  • Usually, diastasis repairs do not have symptoms, are considered cosmetic, and are not covered by insurers.
  • Panniculectomy, or excision of overhanging skin, is sometimes covered if the insurer considers it medically necessary, and if it is a covered benefit.

Your surgeons are probably more knowledgeable about pre-authorization for this kind of surgery in your area than any online consultant. 

Best wishes.

Seattle Plastic Surgeon
4.5 out of 5 stars 28 reviews

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