Prior Auth Required

17111 - does not meet criteria in next column. for severe acne will be considered medically

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Servicedoes not meet criteria in next column. for severe acne will be considered medically
Procedure / Service Description

(cosmetic) (Indications to be supported by medical Authorization - impairment. 10040, 17110, Acne (L70.0-L70.9) treatment that Acne extractions/10040 as an initial treatment Yes 17111 does not meet criteria in next column. for severe acne will be considered medically necessary for treatment of painful inflamed cysts or pustules or when one of the below is

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.