CPT 11445 is referenced in 2 tracked payer policy changes from Providence Health Plan and Humana. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 11445 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Providence Health Plan updated benign skin lesion removal billing guidelines effective immediately (August 2025). Claims for CPT codes 11300-11313, 11400-11446, and 17110-17111 must now be billed with specific diagnosis code groupings (Group 1, Group 2, or Group 3) to be considered medically necessary. Claims submitted without compliant diagnosis codes will be denied as not medically necessary.
This is a revised Medicare Advantage policy for cosmetic and reconstructive surgery that provides updated coverage criteria and billing guidance for various procedures including skin lesion removal, panniculectomy, rhinoplasty, and scar revision. The policy clarifies when reconstructive procedures are considered medically necessary and references applicable Local Coverage Determinations by jurisdiction.
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