Home
Billing codes
15836

PAYER POLICY CHANGES

15836 Insurance Policy Changes

CPT 15836, in plain terms, covers Removing excess skin from the arm, often after weight loss or to improve appearance. CPT 15836 is referenced in 18 tracked payer policy changes from Regence BlueShield, Independence Blue Cross, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 15836 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 15836 on AAPC

Regence BlueShield · Effective Jan 1, 2027Medium impact
Surgical Treatments for Lymphedema and Lipedema
Effective January 1, 2027, liposuction or lipectomy to treat lipedema of the extremities may be considered medically necessary when all listed criteria are met, including surgery by a hospital credentialed, board certified plastic surgeon, an in-person exam confirming the lipedema findings, documented significant physical functional impairment, no response to at least six consecutive months of optimal medical management including complex decongestive therapy and compression therapy, a postoperative plan to continue compression garments, and a surgical plan removing a maximum of 5 liters of aspirate. Liposuction or lipectomy for lipedema in areas other than the extremities, for lipedema when these criteria are not met, and for lymphedema is investigational. Physiologic lymphatic microsurgeries, including lymphovenous bypass, lymphaticovenous anastomosis, and vascularized lymph node transfer, are investigational for all indications, as is lymphatic microsurgery performed during nodal dissection or breast reconstruction to prevent lymphedema.
Regence BlueShield · Effective Jan 1, 2027Medium impact
Surgical Treatments for Lymphedema and Lipedema
This policy has been revised, and the revised policy takes effect January 1, 2027. Liposuction or lipectomy for lipedema of the extremities may be considered medically necessary when all criteria A through G are met. Lymphatic physiologic surgery for lymphedema and liposuction for lymphedema are considered investigational.
Independence Blue Cross · Effective Dec 29, 2025High impact
MA11.073f, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin
Independence Blue Cross updated MA11.073f to reduce the post-bariatric surgery waiting period from 24 to 18 months for panniculectomy and abdominal lipectomy, removed chronic pain as a required indication, added abdominoplasty as medically necessary when performed with panniculectomy/abdominal lipectomy, and revised ICD-10 diagnosis code requirements. Billing teams must update documentation requirements and diagnosis code validation rules effective 12/29/2025.
Humana · Effective Jul 22, 2026Medium impact
Excessive Skin and Subcutaneous Tissue Removal - MEDICAID - KENTUCKY (New)
Humana Kentucky Medicaid has established new coverage criteria for excessive skin and subcutaneous tissue removal procedures. Coverage now requires: (1) functional impairment from excess skin/tissue, (2) medical complications unrelieved by 12+ weeks of prescribed dermatological therapy, and (3) stable body weight maintained for 6+ months. Prior authorization is mandatory for all applicable procedures. This is a NEW policy effective 07/22/2026.
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.
Excellus BlueCross BlueShield · Effective May 21, 2026Medium impact
Abdominoplasty, Panniculectomy, and Lipedema Reduction Surgery 7.01.53
Excellus BlueCross BlueShield policy 7.01.53 has a current effective date of May 21, 2026, and sets medical necessity criteria for abdominoplasty, panniculectomy, and lipedema reduction surgery. Abdominoplasty, including belt lipectomy, is considered cosmetic and not medically necessary for all indications. Panniculectomy is medically appropriate only when all listed criteria are met, including a panniculus of Grade 2 or higher documented by photographs, a skin integrity-related functional impairment refractory to at least three months of prescribed standard medical management, and the weight loss requirements for significant weight loss; lipectomy or liposuction for lipedema requires a documented diagnosis, a clinically significant functional deficit or documented medical complication, and six consecutive months of optimal conservative medical management.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
MA11.073f, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin
Independence Blue Cross reissued MA11.073f on 10/28/2026 with no changes to the current policy, which has been effective since 12/29/2025. Key prior changes (effective 12/29/2025) include: bariatric surgery waiting period reduced from 24 to 18 months, chronic pain removed as a required indication for panniculectomy/abdominal lipectomy, abdominoplasty now covered when performed with panniculectomy or abdominal lipectomy, and ICD-10 diagnosis codes updated with five specific codes now listed as medically necessary. Billing teams should verify current applicability of the 12/29/2025 policy changes if not yet implemented.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
11.08.06l, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin
Independence Blue Cross reissued medical policy 11.08.06l on 10/28/2026 with no substantive changes to panniculectomy and redundant skin excision coverage criteria. However, a prior material change effective 12/29/2025 shortened the required waiting period after bariatric surgery from 24 months to 18 months for panniculectomy coverage eligibility. All ICD-10 CM codes were removed from the policy and archived; providers must now report the most appropriate diagnosis code supporting medical necessity criteria.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
11.08.06l, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin
Independence Blue Cross updated Policy 11.08.06l effective 12/29/2025, shortening the waiting period after bariatric surgery for panniculectomy coverage from 24 months to 18 months. All ICD-10 diagnosis codes were removed from the policy attachment and providers must now report the most appropriate diagnosis code supporting medical necessity criteria. This change streamlines timing for post-bariatric body contouring procedures.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
11.08.03n, Lipectomy and Liposuction
Independence Blue Cross reissued policy 11.08.03n on lipectomy and liposuction, removing ICD-10 code E88.1 (Lipodystrophy, not elsewhere classified) effective 10/01/2025. The policy clarifies that these procedures are covered only when medically necessary (e.g., lipoma removal, breast reconstruction, axillary hyperhidrosis treatment) and excludes cosmetic procedures. Billing teams must verify that claims do not use the deleted E88.1 code and ensure proper medical necessity documentation for covered indications.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
11.08.03n, Lipectomy and Liposuction
Independence Blue Cross reissued policy 11.08.03n on lipectomy and liposuction effective 10/01/2025, removing ICD-10 code E88.1 (Lipodystrophy, not elsewhere classified) from the policy. The coverage criteria remain unchanged—cosmetic procedures are excluded, but medically necessary lipectomy and liposuction for specific indications (lipoma removal, breast reconstruction, axillary hyperhidrosis) remain covered. Billing teams must ensure claims no longer reference the deleted diagnosis code.
Aetna · Identified Sep 29, 2026Medium impact
Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (CPB 0211, reviewed 2026-08-18)
Aetna considers panniculectomy or apronectomy medically necessary when the panniculus hangs below the pubis on high-quality color photographs, the medical records show chronic intertrigo that recurs over 3 months or stays refractory to 3 months of appropriate therapy, and weights have been stable for the most recent 3 months; for bariatric patients, at least 12 months must have elapsed since the bariatric plateau. Repair of a true incisional or ventral hernia is considered medically necessary, and component separation is considered a medically necessary adjunct when a ventral hernia is larger than 10 cm in any direction, involves loss of domain, is 7 to 10 cm wide with a width to rectus abdominis width ratio of 2 or more, is complex with tissue loss, or follows prior failed repairs. Liposuction, lipectomy and excision of excessive skin are considered medically necessary for lipedema of the extremities after pain and disability persist despite 3 months or more of conservative management, and suction lipectomy of the trunk is considered medically necessary for lipedema when the specified pain, functional impairment and conservative-treatment criteria are met. Abdominoplasty, lipoabdominoplasty, suction lipectomy for indications other than lipedema and lymphedema, and panniculectomy that does not meet the criteria are considered cosmetic, repair of diastasis recti is considered not medically necessary, and several ventral hernia techniques, including enhanced-view totally extra-peritoneal repair, TAPPRA and peritoneal flap hernioplasty, are considered experimental, investigational or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (CPB 0211, reviewed 2026-03-26)
Aetna considers panniculectomy or apronectomy medically necessary only when the panniculus hangs below the level of the pubis on high-quality photographs, the panniculus causes chronic intertrigo that recurs over 3 months while receiving appropriate medical therapy or stays refractory to it for 3 months, and the member's weight has been stable for the most recent 3 months, with at least 12 months elapsed since the bariatric plateau for bariatric recipients. Aetna considers repair of a true incisional or ventral hernia medically necessary, and considers component separation a medically necessary adjunct when the hernia is larger than 10 cm in any direction, involves loss of domain, measures 7 to 10 cm with a hernia-to-rectus width ratio of at least 2, is complex with tissue loss, or follows prior failed ventral hernia repairs. Aetna considers liposuction, lipectomy and excision of excessive skin medically necessary for lipedema of the extremities after at least 3 months of failed conservative management and when the listed diagnostic criteria are met, while abdominoplasty, lipoabdominoplasty, suction lipectomy for indications other than lipedema and lymphedema, and repair of diastasis recti are considered cosmetic or not medically necessary.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Surgical Treatments for Lymphedema and Lipedema
Liposuction for lipedema or lymphedema may be considered medically necessary to treat functional impairment when all required criteria are met. For lipedema, the criteria include absence of pitting edema from lipedema, bilateral and symmetrical manifestation with minimal involvement of the feet, disproportionate adipocyte hypertrophy of the extremities, a lack of effect of weight loss measures over six consecutive months, a negative Stemmer sign, and significant physical functional impairment. For lymphedema, the criteria include documented stage II or greater lymphedema on the International Society of Lymphology scale, other possible causes of edema ruled out, and no response to three to six consecutive months of conservative management, a period that was changed from six consecutive months on 10/08/2024.
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.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA11.070e, Lipectomy and Liposuction
Independence Blue Cross reissued MA11.070e with a minor code update effective 10/01/2025, deleting ICD-10 diagnosis code E88.1 (Lipodystrophy, not elsewhere classified) from the lipectomy and liposuction policy. This is a routine annual review with no substantive changes to coverage criteria or billing procedures. Billing teams should remove E88.1 from any internal documentation or claim submission logic related to this policy.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA11.070e, Lipectomy and Liposuction
Independence Blue Cross updated MA11.070e to remove ICD-10 diagnosis code E88.1 (Lipodystrophy, not elsewhere classified) effective 10/01/2025. This is a routine annual code update with no changes to coverage criteria, billing procedures, or medical necessity requirements for lipectomy and liposuction procedures.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA11.070d, Lipectomy and Liposuction
Independence Blue Cross reissued MA11.070d lipectomy and liposuction policy on 04/30/2025 to communicate the Company's continuing position. The policy clarifies coverage criteria for medically necessary lipectomy and liposuction procedures while maintaining exclusion of cosmetic services. Key clinical guideline added: lipedema reduction surgery must be performed by surgeons experienced in lipedema care per 2021 consensus guidelines.

Watch 15836

Get one email when a payer policy names 15836, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

REFERENCE DATA

Payers with rules20

Payers requiring prior auth20

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 15836?

Aetna lists 15836 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 15836?

Ambetter lists 15836 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 15836?

AmeriHealth Caritas lists 15836 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 15836?

Anthem BCBS lists 15836 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 Arizona require prior authorization for 15836?

BCBS Arizona lists 15836 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 15836?

There are 18 tracked policy changes affecting CPT 15836, including updates from Regence BlueShield, Independence Blue Cross, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 15836?

Payers that have issued tracked updates for CPT 15836 include: Regence BlueShield, Independence Blue Cross, Humana, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 15836 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 15836. 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 15836?

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.

See every payer rule for 15836

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 15836 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Surgical Treatments for Lymphedema and Lipedema

Surgical Treatments for Lymphedema and Lipedema

MA11.073f, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin

Excessive Skin and Subcutaneous Tissue Removal - MEDICAID - KENTUCKY (New)

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

Abdominoplasty, Panniculectomy, and Lipedema Reduction Surgery 7.01.53

MA11.073f, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin

11.08.06l, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin

11.08.06l, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin

11.08.03n, Lipectomy and Liposuction

11.08.03n, Lipectomy and Liposuction

Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (CPB 0211, reviewed 2026-08-18)

Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (CPB 0211, reviewed 2026-03-26)

Surgical Treatments for Lymphedema and Lipedema

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

MA11.070e, Lipectomy and Liposuction

MA11.070e, Lipectomy and Liposuction

MA11.070d, Lipectomy and Liposuction

Prior authorization required

Prior authorization required

Prior authorization required

Does Aetna require prior authorization for 15836?

Does Ambetter require prior authorization for 15836?

Does AmeriHealth Caritas require prior authorization for 15836?

Does Anthem BCBS require prior authorization for 15836?

Does BCBS Arizona require prior authorization for 15836?

What insurance policy changes affect CPT 15836?

Which payers have updated policy for CPT 15836?

How do I get notified when CPT 15836 policy changes?

Why do payers change policies for CPT 15836?