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

Question

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!

Jourdan Gottlieb, MD · Answer

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.

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

Answers (1)