Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

 

Cosmetic Procedures

The listed procedures are always considered cosmetic. These policies may not apply to all lines of business such as Federal Employee Program, Medicare Advantage and certain self-insured groups.

For Blue Cross of Idaho`s definition of medically necessary and investigational, please click here. 

last updated 02/03/2014 garcarl

11950 Subcutaneous injection of filling material (eg, collagen); 1 cc or less
11951 Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc
11952 Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc
11954 Subcutaneous injection of filling material (eg, collagen); over 10 cc
11960 Insertion of tissue expander (s) for OTHER THAN BREAST
15775 Punch graft for hair transplant, 1 to 15 punch grafts
15776 Punch graft for hair transplant, more than 15 punch grafts
15819 Cervicoplasty
15820 Blepharoplasty Lower Eyelids
15821 Blepharplasty w.extensive fat pads
15825 Rhytidectomy Necl w/ Platysmal Tightening
15828 Rhytidectomy Cheek and Chin
15829 Rhytidectomy SMAS Flap
15832 Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh
15833 Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg
15834 Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip
15835 Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock
15836 Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm
15837 Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand
15838 Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad
15839 Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area
15847 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen (eg, abdominoplasty, (includes umbilical transposition and fascial plication)
15876 Suction Assist Lipectomy, Head and Neck
15877 Suction Assist Lipectomy, trunk
15878 Suction Assist Lipectomy, upper extremity
15879 Suction Assist Lipectomy, lower extremity
21270 Malar augmentation, prosthestic material (cheek implants)
21275 Revision of orbitocraniofacial reconstruction
21280 Medial canthopexy (eyelid surgery)
21282 Lateral canthopexy (eyelid surgery) 
30430 Rhinoplasty, secondary; minor revision (small amount of nasal tip work)
30435 Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) 
30450 Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) 
36468 Single or multiple injections of sclerosing solutions, spider veins (telangiestasia); limb or trunk
36469 Single or multiple injections of sclerosing solutions, spider veins (telangiestasia); face
69090 Ear piercing
69300 Otoplasty, protruding ear, with or without size reduction

To also check our always investigational list, please click here.

To also check our prior authorization list, please click here.