Skip to main content
HealthPartners

Coverage criteria policies

Scar Revision/Keloids

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific 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 scar revision.

Coverage

Scar revision is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

  1. The scar revision is incidental to or follows an initial surgery resulting from injury, illness or disease of the involved body part.
  2. The scar is not as a result of an initial surgery but has caused a functional impairment and the revision will restore the function or significantly reduce the impairment. A functional impairment is one that interferes with the ability to perform activities of daily living (such as a contracture that results in limitation of normal joint movement) as determined by our Medical Director or his or her designee.

Indications that are not covered

  1. Scar revisions that do not meet the above criteria listed under “Indications that are covered” are considered cosmetic and are not covered.
  2. Additional scar revision surgeries beyond the initial revision surgery are not covered unless:
    1. The scar revision is being done as a staged procedure; or
    2. The initial scar revision resulted in a medically adverse or unanticipated outcome.

Definition

A scar is a permanent mark resulting from a wound or disease process in tissue, especially in skin.

Keloid is a thick, hyperplastic scar resulting from excessive growth of fibrous tissue and occurring especially after burns, radiation injury, or severe cutaneous disease.

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.

Go to

Policy activity

  • 10/01/1995 - Date of origin
  • 05/25/2017 - Effective date
Review date
  • 04/2017

Related content