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Coverage criteria policies

Hemangioma Treatment

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for hemangioma treatment.

Coverage

Hemangioma treatment is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

  1. Documentation of recurrent bleeding; OR
  2. Enlargement that causes functional impairment (e.g., interfering with vision, breast feeding or eating)

Indications that are not covered

Any reason other than the above would be considered cosmetic and is excluded from coverage in your member contract. Please see related content at the right for the link to Cosmetic Coverage Criteria policy.

Definitions

A hemangioma is a non-cancerous skin discoloration which is small or not present at birth. It enlarges rapidly in the first year of life and may resolve over the next 5-10 years. It is not considered a port wine stain (nevus flammeus).

A port wine stain (nevus flammeus) is a flat pink, red or purplish lesion that is present at birth. It may become darker over time. It frequently occurs on the face but may also be present elsewhere and generally does not enlarge out of proportion or resolve over time.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

ICD-10-CM Codes

Codes

Description

D18.01

Hemangioma of skin and subcutaneous tissue

Q82.5

Congenital non-neoplastic nevus

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 10/01/1995 - Date of origin
  • 10/01/1995 - Effective date
Review date
  • 05/2016

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