CalVCB will review cosmetic surgery estimates to give providers and applicants advanced notice if CalVCB can reimburse the requested procedures and how much.
Email preauthorizationrequest@victims.ca.gov:
- Surgeon fee
- Facility fee
- Anesthesia fee
- CPT codes
- Costs for each category
- Other documentation showing the injuries are a direct result of the crime.
Providers are not required submit the estimate on a CMS 1500.
CalVCB will determine if the recommended service:
- is medically necessary; or
- will best aid the claimant; and
- is related to the qualifying crime.
CalVCB may request additional information.
An applicant does not have the right to appeal a preauthorization denial because they did not suffer a pecuniary loss. The applicant may still undergo the cosmetic surgery procedure and submit the incurred costs to CalVCB for reimbursement with the understanding CalVCB may not reimburse these costs.
Providers must submit cosmetic bills on a standardized CMS 1500 or 1450 form containing:
- Patient’s name and address
- Date(s) of service
- Type(s) of service(s) provided (CPT codes)
- Billed amount
- Provider’s license number, federal tax identification number (FEIN or SSN), business address, telephone number, signature or signature stamp
- Billing date
The surgeon, facility, and anesthesia fees are paid at 80% of the billed amount. Facility and anesthesia fees are subject to be reimbursed at the Medicare rate if the procedures are outsourced to a different facility and not completed in-house.
