Rosacea (CPB 0547, reviewed 2026-08-21)

Immediately: Billing team must update claim submission rules and denial protocols in billing system: (1) DENY all claims for CPT 15780-15793, 17000-17111, 17340, 17360, 96931-96936, 0232T, and 82247, 82248, 84550 when billed for rosacea treatment, as these are designated experimental/investigational or cosmetic and not covered. (2) ONLY ALLOW CPT 10040 and 30120 when supported by medical documentation proving refractory bleeding/infection requiring repeated cautery or frequent antibiotics—update encounter forms to require this documentation. (3) DENY all claims for biomarker testing (interleukins, interferons, chemokines, TNF-alpha, TGF-beta, matrix metalloproteases, transcription factors, serum bilirubin/uric acid/zonulin, endocan, GI microbiome, and reflectance confocal microscopy codes 96931-96936) for rosacea diagnosis or monitoring. (4) Update billing software edits to cross-reference ICD-10 codes L71.0-L71.9 and deny non-covered procedures automatically. (5) Notify providers in writing of coverage restrictions and train front-desk staff on pre-authorization requirements. Failure to implement these rules will result in claim denials and potential recovery of incorrectly paid claims.