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15775

PAYER POLICY CHANGES

15775 Insurance Policy Changes

CPT 15775, in plain terms, covers A minor hair transplant procedure where the doctor moves one to fifteen small hair plugs to areas of baldness. CPT 15775 is referenced in 6 tracked payer policy changes from Blue Shield of California, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 15775 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 15775 on AAPC

Blue Shield of California · Effective Nov 1, 2026Medium impact
Cosmetic and Reconstructive Procedures (BSC7.08)
Effective November 1, 2026, Blue Shield of California's Cosmetic and Reconstructive Procedures policy (BSC7.08) has an updated policy statement, guidelines, literature and coding. Reconstructive procedures may be considered medically necessary when the policy criteria are met, including surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. Procedures such as breast augmentation with implants (19325), breast lift (19316), dermabrasion (15780-15783), hair transplant (15775, 15776), tattooing and tattoo removal (11920-11922), and ear or body piercing (69090) are typically considered cosmetic and not medically necessary for all indications unless the policy says otherwise. A procedure may be denied as not medically necessary if it is likely to result in only minimal improvement in appearance, if the treating surgeon cannot or will not provide sufficient documentation, if there is an alternative approved intervention with equal or superior clinical outcomes, or if it is for cosmetic purposes only.
Excellus BlueCross BlueShield · Effective Sep 17, 2026Medium impact
Cosmetic and Reconstructive Procedures 7.01.11
Policy 7.01.11 treats reconstructive procedures as medically appropriate only when a functional deficit is documented, a reconstructive purpose is documented, and the indication-specific criteria are met, such as the criteria for acne surgery, benign skin lesion removal, breast procedures, pectus repair, dermabrasion, otoplasty, hypertrophic scar revision, and vulvectomy as part of cancer surgery. Procedures that reshape structures to improve appearance or self-esteem without a functional deficit, including breast augmentation with implants, breast lift, rhytidectomy, tattooing, chemical peels, hair transplant, hair removal, and non-surgical body sculpting, are considered cosmetic and not medically necessary for all indications unless the reconstructive criteria are met. Cryotherapy for acne, certain hyperhidrosis treatments, and autologous melanocyte transplantation for vitiligo are investigational.
Independence Blue Cross · Effective Sep 14, 2026Medium impact
11.08.01i, Hair Transplants and Cranial Prostheses (Wigs)
Independence Blue Cross updated policy 11.08.01i to clarify coverage for hair transplants and cranial prostheses (wigs). The policy emphasizes that individual benefits must be verified before billing, requires specific medical documentation including color photographs and provider letters of medical necessity for hair transplants, and establishes clear criteria for wig coverage (6+ month projected hair loss duration, provider-ordered). Language was revised for clarity but coverage criteria remain substantively consistent.
Excellus BlueCross BlueShield · Effective May 21, 2026Medium impact
Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members 7.01.84
Policy 7.01.84 sets the criteria for gender affirming surgery and treatments for commercial and Medicare Advantage members, with a current effective date of May 21, 2026. Gender affirming surgery may be considered medically necessary when the member has reached age 18 (except for mastectomy), one letter from a qualified professional documents gender dysphoria that is marked and sustained for at least 6 months, and the other general criteria are met. Breast augmentation, hysterectomy, gonadectomy and genital reconstructive surgery each require six months of continuous hormone therapy or a documented contraindication to hormone therapy, and voice modification and voice therapy require review by a Health Plan Behavioral Health Medical Director.
Regence BlueShield · Effective Apr 1, 2026Medium impact
Gender Affirming Interventions for Gender Dysphoria
Gender affirming interventions for gender dysphoria may be considered medically necessary when the criteria for the member's contract type are met. For member contracts subject to Washington's Gender Affirming Treatment Act (SSB 5313) or Oregon Reproductive Health Rights (HB 2002), the criteria include a diagnosis of gender dysphoria by a licensed mental health professional, six continuous months of hormone therapy in the prior 12 months unless hormones are not clinically indicated, six months of living in a role congruent with the patient's identity, and either age 18 or older or documented medical necessity of earlier intervention for a non-genital request. For all other member contracts, the criteria include age of at least 18 years, the same diagnosis, hormone and living-role requirements, and either a listed surgical procedure such as vaginoplasty, orchiectomy or breast/chest surgery or a listed procedure such as hair removal or facial gender confirmation surgery when documentation shows it would improve significant gender dysphoria; reversal of gender affirming interventions and revisions made because of dissatisfaction with appearance are considered not medically necessary.
Excellus BlueCross BlueShield · Effective Jan 22, 2026Low impact
Gender Reassignment/Gender Affirming Surgery and Treatments for Medicaid Managed Care Plan (MMCP) and Health and Recovery Plan (HARP) Members 7.01.105
Effective January 22, 2026, gender reassignment surgery is considered medically appropriate for members age 18 or older who have referral letters from two qualified NYS licensed health professionals, and the policy lists the covered surgeries and services for Medicaid Managed Care Plan and Health and Recovery Plan members. The January 22, 2026 annual review moved the hormone therapy criteria to Pharmacy policies with policy intent unchanged, and a March 20, 2026 policy edit revised policy statement references for alignment, also with intent unchanged.

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REFERENCE DATA

Payers with rules14

Payers requiring prior auth14

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
Blue Shield of California · Effective November 1, 2026
Prior authorization required
Prior Authorization List for Blue Shield Medicare

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 15775?

Aetna lists 15775 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Ambetter require prior authorization for 15775?

Ambetter lists 15775 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 15775?

AmeriHealth Caritas lists 15775 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 15775?

Anthem BCBS lists 15775 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 15775?

BCBS Michigan lists 15775 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 15775?

There are 6 tracked policy changes affecting CPT 15775, including updates from Blue Shield of California, Excellus BlueCross BlueShield, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 15775?

Payers that have issued tracked updates for CPT 15775 include: Blue Shield of California, Excellus BlueCross BlueShield, Independence Blue Cross, Regence BlueShield.

How do I get notified when CPT 15775 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 15775. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 15775?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 15775 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Cosmetic and Reconstructive Procedures (BSC7.08)

Cosmetic and Reconstructive Procedures 7.01.11

11.08.01i, Hair Transplants and Cranial Prostheses (Wigs)

Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members 7.01.84

Gender Affirming Interventions for Gender Dysphoria

Gender Reassignment/Gender Affirming Surgery and Treatments for Medicaid Managed Care Plan (MMCP) and Health and Recovery Plan (HARP) Members 7.01.105

Prior authorization required

Prior authorization required

Prior authorization required

Does Aetna require prior authorization for 15775?

Does Ambetter require prior authorization for 15775?

Does AmeriHealth Caritas require prior authorization for 15775?

Does Anthem BCBS require prior authorization for 15775?

Does BCBS Michigan require prior authorization for 15775?

What insurance policy changes affect CPT 15775?

Which payers have updated policy for CPT 15775?

How do I get notified when CPT 15775 policy changes?

Why do payers change policies for CPT 15775?