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Update: E&M Services Billed in Conjunction with Skin Tag/Skin Lesion Procedures

Effective November 1, 2014, Evaluation and Management (E&M) services billed on one day for a member for the same diagnosis by the same provider as any of the skin tag and/or skin lesion procedures listed below will be considered incidental to that skin tag and/or skin lesion procedure and will not be eligible for separate reimbursement even if the E&M service is appended with a modifier 25.

Skin tag procedures
11200, 11201

Skin lesion procedures
17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111, 17250, 17260, 17261, 17262, 17263, 17264, 17266, 17270, 17271, 17272, 17273, 17274, 17276, 17280, 17281, 17282, 17283, 17284, 17286

This change will impact claims submitted by participating physicians/other healthcare professionals and nonparticipating physicians/other healthcare professionals for services provided to members enrolled in all Horizon BCBSNJ insured and Administrative Services Only plans.

Participating physicians and other healthcare professionals may not seek reimbursement from our member for any such incidental services.

This policy does not apply to claims submitted for BlueCard®(out of-area) members or for claims where Horizon BCBSNJ is the secondary carrier (i.e., Medicare primary or Coordination of Benefits claims).

Our reimbursement policy for Skin Tags and/or Skin Lesions with E&M is available online for your review.

CPT® is a registered trademark of the American Medical Association.

Published on: July 29, 2014, 01:57 a.m. ET
Last updated on: November 24, 2020, 23:21 p.m. ET