Skin tags, medically known as acrochordons, are common, benign growths made up of collagen fibers and blood vessels encased in skin. They typically appear in areas where skin rubs against skin or clothing, such as the neck, armpits, or groin. The core question regarding their removal is whether insurance will cover the procedure, and the answer is generally no. Most insurance plans, including Medicare, classify the removal as an elective procedure, meaning the patient must pay the cost out-of-pocket.
The Standard: Removal as a Cosmetic Procedure
Insurance companies categorize medical services based on whether they treat a disease, injury, or functional impairment. Skin tag removal is denied in the majority of cases because the growths are classified as benign, asymptomatic lesions that do not negatively affect bodily function. The insurance industry views the decision to remove a non-symptomatic skin tag as a choice made primarily for aesthetic reasons.
This classification means the removal is considered an elective enhancement rather than an essential medical treatment. For a procedure to be covered, the healthcare provider must submit specific diagnostic codes (ICD-10 codes) that indicate a pathology or functional problem. Claims submitted without a medical justification are routinely rejected.
Since most skin tags are small, painless, and pose no health risk, their removal falls outside the scope of what is considered medically necessary. Patients should expect to be responsible for the full cost when the only motivation for removal is cosmetic.
Defining Medically Necessary Removal
Coverage for skin tag removal is possible only when the condition meets the criteria for medical necessity, meaning the skin tag is causing a documented physical impairment or pathology. One common qualifying condition is chronic irritation, bleeding, or infection caused by constant friction, often resulting from rubbing against clothing or skin folds.
The skin tag’s location may also qualify for coverage if it physically obstructs a bodily function. For instance, a large skin tag located on the eyelid that impairs vision would be considered medically necessary to remove. A tag causing significant pain or interfering with physical movement can also warrant coverage.
In rare instances, if a skin growth appears atypical (such as exhibiting unusual color, rapid growth, or irregular shape), a physician may need to remove it for a biopsy to rule out malignancy. When removal is performed to obtain tissue for pathological examination, the procedure is generally covered, regardless of the ultimate benign diagnosis.
To secure pre-authorization for a symptomatic tag, the physician must provide detailed clinical notes and sometimes photographic evidence to the insurer documenting the chronic symptoms or functional obstruction. The ICD-10 code L91.8, which denotes “Other hypertrophic disorders of the skin,” is commonly used to justify medical necessity, but it must be paired with documentation detailing the symptomatic complaint. Without clear documentation of physical symptoms, the claim is likely to be processed as cosmetic, even with the correct diagnostic code.
Understanding the Costs When Insurance Declines
When insurance declines coverage because the removal is deemed cosmetic, the patient is responsible for the full out-of-pocket cost. The price can vary significantly based on location, the number of tags being removed, and the specific removal technique used by the provider. Common removal methods include cryotherapy (freezing), cauterization (burning), and simple excision (cutting).
For the cosmetic removal of a small group of skin tags (generally up to 15 lesions), patients can expect to pay an average of $150 to $300. Some providers charge a set fee for the first 15 tags and a reduced fee for each additional group of 10 tags. It is important to confirm whether the consultation fee is separate from the procedure fee.
In addition to the removal cost, there may be an additional pathology fee, ranging from $50 to over $200, if the physician sends the removed tissue to a lab for microscopic examination. Patients should proactively inquire about the total cost before the procedure, including all potential fees, to avoid unexpected billing.