CommercialPrior AuthMedium impact
New Lipedema Policy Requires Prior Authorization
CareFirst BlueCross BlueShield·Plastic Surgery, General Surgery·Prior Authorization
Effective date
Sep 1, 2023
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield now requires prior authorization for all lipedema surgical procedures effective September 1, 2023. Three specific CPT codes (15877, 15878, 15879) will require prior authorization for all commercial lines of business excluding FEP.
Action Required
Before September 1, 2023: Billing team must update system to require prior authorization for CPT codes 15877, 15878, and 15879 for all CareFirst commercial plans (excluding FEP). Update encounter forms and notify providers that lipedema surgical procedures now require prior auth. Review CareFirst authorization training under 'CareFirst Essentials' on the Learning and Engagement Center for submission assistance.