We are writing to inform you of the update to prior authorization requirements for Destruction Procedures on Benign or Premalignant Lesions of the Integumentary System (CPT-17250) when submitted with diagnosis Umbilical granuloma (P83.81) or newborn affected by unspecified condition of umbilical cord (P02.60). 

Effective immediately, Jefferson Health Plans will remove the prior authorization requirements for CPT code 17250 when submitted with diagnosis P83.81 or P02.60 when billed with a place of service of 11 (office) for participating providers. If CPT 17250 is requested with any other diagnosis and/or other place of service, prior authorization will be required.

If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday - Friday, 9:00 a.m. – 5:30 p.m.).