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​Change to medical policy on injectable dermal fillers for cosmetic procedures

March 31, 2023

Effective July 1, 2023, Independence Blue Cross (Independence) and Independence Administrators will update their medical policy on injectable dermal fillers for cosmetic procedures for Medicare Advantage and Commercial members.

For Medicare Advantage, a section under the heading OTHER DERMAL FILLERS will be added to further expand upon the existing cosmetic position by including specific examples of what are considered to be cosmetic and therefore not covered.

The following codes will also be added:

  • 11950 Subcutaneous injection of filling material (e.g., collagen), 1 cc or less
  • 11951 Subcutaneous injection of filling material (e.g., collagen), 1.1 to 5.0 cc
  • 11952 Subcutaneous injection of filling material (e.g., collagen), 5.1 to 10.0 cc
  • 11954 Subcutaneous injection of filling material (e.g., collagen), over 10.0 cc
  • Q4112 Cymetra™, injectable, 1 cc

For Commercial, the coverage position of medical necessity of Radiesse® for the treatment of unilateral vocal cord paralysis will be removed. This is because the product is no longer being marketed and instructed for use by the manufacturer and the U.S. Food and Drug Administration (FDA) for this indication. It is now only marketed and instructed to use as a product for moderate-to-severe lower face wrinkles and volume loss in the hands. As these are both considered to be cosmetic services, they are not covered.

The following code will be added: Q4112 Cymetra™, injectable and 1cc

For more information, please view the following notifications that were published on March 31, 2023:


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