New Lipedema Policy Requires Prior Authorization
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) is continually working with healthcare delivery partners to optimize Utilization Management (UM) strategies to increase efficiencies and control costs while ensuring members receive affordable, quality care. Prior Authorization helps balance access with appropriate utilization services. Effective September 1, 2023, CareFirst will require prior authorization for all commercial lines of business (excluding FEP) for a new policy, Surgical Treatment of Lipedema 7.01.148.
What codes now require prior authorization?
The following Current Procedural Terminology (CPT) codes will now require prior authorization:
- 15877
- 15878
- 15879
Next Steps
The policy will be live in our Medical Policy database on September 1.
If you need assistance submitting a prior authorization, review our authorization training under ‘CareFirst Essentials’ on the Learning and Engagement Center.