Documentation Needs for Diagnosing Lipedema

The Blue Cross Blue Shield of North Dakota (BCBSND) Utilization Management team is implementing a new medical policy in May 2023 to address the treatment for the diagnosis of lipedema. This policy will have specific criteria needed to review for this service for both our Commercial and Medicaid Expansion line of business. Documentation acquired during a physical examination and colored photos are required.
Documentation requirements for lipedema
To determine the medical necessity of the request for the diagnosis of lipedema, the following documentation must be provided at the time of the request.
Medical records to include documentation of all the following:

  • All medical records and chart note pertinent to the request including:
    • History
    • Physical examination
    • Treatment plan
    • Colored Photos

The new policy will be added early May 2023 and will be under Medical Policy Search on our BCBSND provider webpage.