I'm a provider
You will be redirected to myBlue. Would you like to continue?
Please wait while you are redirected.
Please enter a username and password.
Tattooing is the introduction, by punctures, of permanent colors in the skin. Tattooing has expanded beyond the traditional decorative practice. Tattoos are now widely promoted for permanent make-up applications, in which pigments are injected intradermally to provide permanent eyeliner, lip-liner, or eye shadow. Additionally, tattooing may be used to cover birthmarks or scars, as well as in breast reconstruction to provide an areola and/or nipple for the reconstructed breast.
In the absence of documentation that the procedure was performed to restore/improve bodily function or to correct deformity resulting from disease, trauma, or previous therapeutic process, the procedure should be considered cosmetic. Excision/treatment of decorative tattoos is considered cosmetic and therefore, not eligible for coverage.
Excision/treatment of tattoos of traumatic or therapeutic origins may be considered eligible for coverage.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY6/1994: Approved by Medical Policy Advisory Committee (MPAC)
2/7/2002: Investigational reference deleted under "Code Reference" section
4/25/2002: Type of Service and Place of Service deleted. Code Reference section completed
6/7/2002: Code Reference section updated, ICD-9 procedure code 86.25, 86.3 added
11/19/2004: Code Reference section updated, CPT code 11950, 11951, 11952, 11954 deleted, ICD-9 procedure code 86.3 deleted, ICD-9 diagnosis code 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9, 198.81, 233.0 added covered codes
4/1/2008: Policy reviewed, no changes
12/24/2008: Coding updated per 2009 CPT/HCPCS revisions
11/08/2010: Added ICD-9 code V45.71 to the Covered Codes table.
03/27/2014: Policy reviewed; no changes.
08/27/2015: Code Reference section updated to add ICD-10 codes. Added ICD-9 diagnosis codes 175.0 and 175.9.
FDA Medical Bulletin (5/1994)
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.