Endovenous vein ablation (36475 RF, 36478 laser) is covered for documented saphenous reflux after a failed compression trial — not for spider veins or appearance.

Breast reduction (CPT 19318) coverage isn’t only the Schnur gram threshold — two documented symptoms can qualify it, and prior auth decides whether it pays.

Functional blepharoplasty (CPT 15823) is covered only when excess eyelid skin blocks vision — and the visual field test, not the photo, is what proves it.

Lipedema liposuction (CPT 15877-15879) uses the same codes as cosmetic lipo, so payers deny by default. The documentation that actually gets it covered.

Therapeutic Botox (J0585 + 64615) is covered for chronic migraine and more — but the unit count, JW/JZ wastage, and failed-preventive gate decide the claim.

Benign lesion removal (CPT 17110, 11400-11446) is covered only when symptomatic — and the ICD-10 diagnosis, not the procedure, decides whether it pays.

Septoplasty (30520) is covered for functional nasal obstruction, not for a deviated septum on its own. The line is documented obstruction plus failed medical therapy.

CPT 11102, 11104, and 11106 are biopsy primaries by technique. Use multiple techniques in one visit and you still report one primary plus add-ons, not two primaries.

CPT 17110 covers up to 14 benign lesions in one unit, not one per lesion. Bill it per lesion and the payer strips the overage before it pays.

The Core Problem: One Code, Many Techniques The technique changes depending on the patient. The CPT code doesn’t. For top surgery — augmentation, reduction, mastectomy with nipple reconstruction — reimbursement is tied to the standard diagnosis for that procedure type. A reduction for macromasty and a reduction for masculinization carry the same code, same reimbursement, […]