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    v1.0.31
    OpenPayerPolicy UpdatesDermatologyAnthem Cosmetic Skin Coverage Update | OpenPayer
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    ModifiedAnthemPolicy ANC.00007

    Cosmetic and Reconstructive Services: Skin Related

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    Governs coverage of cosmetic, reconstructive, and medically necessary nonpharmacological skin procedures (e.g., chemical peels, dermabrasion, lasers, hair procedures, tattooing) for Anthem members.

    Policy Summary
    PayerAnthem
    PolicyCosmetic and Reconstructive Services: Skin Related
    Policy CodePolicy ANC.00007
    Change TypeRevised — coding and coverage updates
    Effective DateJan 6, 2026
    Last ReviewNov 6, 2025
    Next Review DateNov 6, 2025
    Key ActionVerify prior authorization and coding requirements for listed procedure codes and note removal of CPT 36468 before claim submission.
    SourceLink
    POLICY UPDATE CHANGES

    Removed telangiectasia from the position statement section and revised formatting of position statement sections regarding Other Cosmetic Skin Procedures and Tattooing.

    Added microneedling as a cosmetic and not medically necessary indication.

    Updated Coding section; removed CPT code 36468 no longer addressed.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    7Named procedure categories (A–G)
    ANC.00007Policy identifier
    NCApplicable state(s)
    11/06/2025Most recent revision

    Coverage Criteria (Medically Necessary vs Cosmetic)

    inv-01: Chemical Peels - Medically Necessary Criteria

    Covered when ALL of the following are met

    Chemical peels for active acne: Chemical peels (epidermal peels) are considered medically necessary for active acne.
    Medium or deep (dermal) peels for actinic/pre-malignant lesions: Medium or deep chemical peels are medically necessary when there is documented evidence of 10 or more actinic keratoses or other pre-malignant skin lesions AND failure of topical retinoid treatment, topical chemotherapeutic agents, and cryotherapy.>= 10 actinic keratoses

    inv-02: Vascular Lesions - Medically Necessary / Reconstructive Criteria

    Covered when ALL of the following are met

    Medically necessary vascular lesion treatment: Treatment of cutaneous hemangioma, port wine birthmark, or other vascular lesions is medically necessary when there is documented evidence of significant functional impairment (for example, bleeding or a lesion which interferes with vision) AND the procedure can be reasonably expected to improve the functional impairment.
    Reconstructive indication: Treatment using lasers or other methods to restore appearance may be considered reconstructive when intended to address a significant variation from normal related to a congenital defect.

    inv-03: Dermabrasion - Medically Necessary Criteria

    Covered when ALL of the following are met

    Dermabrasion for pre-malignant/malignant lesions: Dermabrasion (including abrasion, salabrasion) is medically necessary for the treatment of actinic keratoses, other pre-malignant skin lesions and localized non-melanoma malignant skin lesions (examples: basal cell carcinoma, carcinoma in-situ).

    inv-04: Hair Procedures - Medically Necessary Criteria

    Covered when ALL of the following are met

    Permanent hair removal medically necessary indications: Permanent removal of hair is medically necessary for recurrent infected cysts, hair follicle infections, or after surgical treatment of pilonidal sinus disease.

    inv-05: Rosacea - Medically Necessary Criteria

    Covered when ALL of the following are met

    Laser/surgical rosacea: Laser or surgical management of rosacea is medically necessary when the rosacea is severe, refractory to standard medical therapy, and preoperative photos document the clinical skin changes requiring treatment.

    Documentation should include prior trials of standard medical therapy and preoperative photographs.

    inv-06: Other Cosmetic Procedures - Not Medically Necessary

    Not covered when intended solely for cosmetic purposes

    Procedures considered cosmetic and not medically necessary: Procedures to treat skin irregularities such as wrinkles, acne scars, or blemishes (including laser skin resurfacing and microneedling/percutaneous collagen induction therapy) are considered cosmetic and not medically necessary when performed in the absence of a significant functional impairment.

    Microneedling explicitly identified as cosmetic and not medically necessary.

    inv-07: Tattooing and Tattoo Removal

    Tattooing medically necessary: Tattooing (including micropigmentation) is medically necessary when performed as part of a medically necessary therapeutic treatment (for example, related to radiation therapy) and may be reconstructive when performed as part of covered breast reconstruction.

    See coding section for supporting ICD-10 diagnosis ranges for reconstructive indications (e.g., malignant neoplasm of breast).

    Tattoo removal: Removal or excision of a tattoo is considered cosmetic and not medically necessary for all indications.

    inv-08: Tattooing — Medically Necessary vs Cosmetic

    Tattooing (CPT 11920-11922) coverage logic:

    Medically necessary tattooing: Tattooing (CPT 11920-11922) is medically necessary when performed to correct color defects or as part of reconstructive care for diagnoses such as malignant neoplasm of the breast, carcinoma in situ, neoplasm of uncertain behavior of the breast, personal history of breast malignancy, or encounters for antineoplastic radiation therapy.

    Refer to the coding section for applicable ICD-10 diagnosis code ranges.

    Cosmetic tattooing: Tattooing is cosmetic and not medically necessary when the reconstructive or medically necessary criteria are not met.

    inv-09: Other Cosmetic Skin Procedures - Other skin procedures coverage logic

    Other skin procedures coverage logic:

    Cosmetic classification for unlisted skin procedures: Procedures described by an unlisted skin procedure CPT (for example, 17999 when specified as laser skin resurfacing, tattoo removal other than by dermabrasion, or microneedling) are considered cosmetic and not medically necessary when indicated in the Position Statement as cosmetic.

    Microneedling explicitly added as cosmetic and not medically necessary in the policy history.

    This policy does not address certain procedures and modalities that are managed under other guidelines. Specifically, it excludes gender-affirming surgery or procedures, select light therapies for vitiligo (for example, home ultraviolet A/PUVA or B/Excimer devices), and telangiectasia or other venous surgery; criteria for these services are found in the applicable plan guidelines referenced in the policy.

    Per the policy definitions, services described in this document are considered medically necessary only when there is documented significant functional impairment and the procedure can reasonably be expected to improve that impairment; reconstructive services address significant variation from normal related to injury, disease, trauma, treatment, or congenital defect. Benefit language may supersede this document for reconstructive services.

    When the documented criteria for a procedure are not met, the service is classified as Cosmetic and Not Medically Necessary. The policy specifies that codes listed for the various procedures (e.g., chemical peels, dermabrasion, laser treatments, microneedling, tattoo removal specified under unlisted CPT 17999) are considered cosmetic and not medically necessary when performed in the absence of a documented significant functional impairment or reconstructive indication.

    Examples of modalities explicitly called out as cosmetic and not medically necessary when criteria are unmet include laser skin resurfacing, microneedling, and procedures described by CPT 17999 when specified as laser skin resurfacing, tattoo removal other than dermabrasion, or microneedling.

    The policy notes that when medically necessary or reconstructive criteria are not met for listed procedure codes, services will be treated as cosmetic and may be denied per plan adjudication rules.

    The policy lists examples of procedures that are considered cosmetic when performed solely to change appearance within the range of normal anatomic variation. Representative examples include treatment of photoaged skin, wrinkles, acne scarring, and uneven epidermal pigmentation.

    Other listed cosmetic-only procedures include hairplasty for androgenetic alopecia and temporary or permanent hair removal (electrolysis, lasers, waxing) when not done to address a significant functional impairment.

    Procedures used for aesthetic rejuvenation such as laser skin resurfacing and minimally invasive approaches like microneedling are described in the background and are considered cosmetic when not meeting medical necessity or reconstructive criteria.

    Microneedling (also called percutaneous collagen induction therapy or skin needling) is specifically identified in the policy as a procedure considered cosmetic and not medically necessary when performed to change appearance without significant functional impairment.

    The policy states that procedures described under CPT 17999—when specified as laser skin resurfacing, tattoo removal (other than by dermabrasion), or microneedling—are considered cosmetic and not medically necessary when they meet the Position Statement criteria for cosmetic services.

    The history and revisions explicitly note that microneedling was added to the list of cosmetic and not medically necessary indications during prior updates to the policy; providers should reference the coding section when submitting claims for unlisted procedure codes.

    Coding and Billing (CPT/ICD-10/Procedure Codes)

    Chemical peel CPT codesCPT
    15788-15789Chemical peel, facial
    15792-15793Chemical peel, nonfacial
    Vascular lesion CPT codesCPT
    17106-17108Destruction of cutaneous vascular proliferative lesions (eg, laser technique)
    Dermabrasion / Abrasion CPT codesCPT
    15780-15782Dermabrasion
    15786-15787Abrasion (lesion)
    15783Dermabrasion; superficial, any site (eg, tattoo removal)
    Hair procedures CPT codesCPT
    17380Electrolysis epilation, each ½ hour
    17999Unlisted procedure, skin, mucous membrane and subcutaneous tissue
    Rosacea / unlisted dermatology CPT codesCPT
    96999Unlisted special dermatological service or procedure
    Other / unlisted CPT codesCPT
    17999Unlisted procedure, skin, mucous membrane and subcutaneous tissue (laser skin resurfacing, tattoo removal, microneedling)
    Tattooing CPT codesCPT
    11920-11922Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation
    Selected ICD-10 diagnosis code rangesICD-10
    C44.00-C44.99Basal cell, squamous cell, other or unspecified malignant neoplasm of skin
    L57.0Actinic keratosis
    L70.0-L70.9Acne
    D18.00Hemangioma unspecified site
    Q82.5Congenital non-neoplastic nevus
    L71.0-L71.9Rosacea
    C50.011-C50.929Malignant neoplasm of breast
    ICD-10-PCS procedure codesICD-10
    0HDSXZZExtraction of hair, external approach (ICD-10-PCS)
    0HRSX7ZReplacement of hair with autologous tissue substitute, external approach (ICD-10-PCS)
    Other services - cosmeticCPTNot Covered
    17999Unlisted procedure, skin, mucous membrane and subcutaneous tissue [when specified as laser skin resurfacing, tattoo removal (other than by dermabrasion), or microneedling]
    Tattooing - potentially medically necessaryCPTCovered
    11920-11922Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation
    ICD-10-Procedure for tattooingICD-10
    3E00XMZIntroduction of pigment into skin and mucous membranes, external approach
    Diagnosis codes supporting reconstructive tattooing (breast)ICD-10
    C50.011-C50.929Malignant neoplasm of breast (range)
    C79.81Secondary malignant neoplasm of breast
    D05.00-D05.92Carcinoma in situ of breast (range)
    D48.60-D48.62Neoplasm of uncertain behavior of breast (range)
    Z85.3Personal history of malignant neoplasm of breast
    Removed/updated codesCPT
    36468Code removed from policy (no longer addressed)
    Number of actinic keratoses — dermal chemical peels
    Threshold>= 10 actinic keratoses for medium/deep (dermal) chemical peels
    ContextApplies to medium or deep chemical peels (dermal peels) for actinic or pre-malignant skin lesions
    Prior therapy requirementFailure of topical retinoid, topical chemotherapeutic agents, and cryotherapy required

    Provider Actions, Documentation & Prior Authorization

    Documentation Required

    Rosacea: documentation and photos

    Laser or surgical management of rosacea is considered medically necessary when the rosacea is severe, refractory to standard medical therapy, and preoperative photos document the clinical skin changes requiring treatment. Providers should submit clear clinical documentation of failure of conservative therapy (for example, topical agents and a trial of oral antibiotics when indicated) and include dated, high-quality preoperative photographs showing the affected areas and severity.

    • Conservative therapy: document trials of topical agents (eg, topical antibiotics, azelaic acid, metronidazole) and systemic therapy where appropriate (eg, oral antibiotics) with dates and response.
    • Photos: include dated, high-resolution preoperative photos demonstrating clinical signs (erythema, papules/pustules, telangiectasia, rhinophyma) and that less invasive measures were insufficient.
    Documentation Required

    Documentation for reconstructive tattooing

    For tattooing performed as part of breast reconstruction or other reconstructive indications, document the diagnosis linking the tattooing to reconstructive intent (for example, postmastectomy reconstruction) and include operative reports or reconstruction plan notes. Submit relevant diagnosis codes and history (such as prior mastectomy, reconstruction procedure codes, and tumor or cancer history) to support reconstructive necessity.

    Background and Scope

    This policy governs coverage for a range of nonpharmacologic procedures used to manage skin conditions, from active acne and pre-malignant or malignant lesions to vascular birthmarks and cosmetic concerns. Techniques addressed include chemical peels, dermabrasion/abrasion, lasers, sclerotherapy, hair procedures, tattooing, and other procedural skin therapies.

    Procedures are classified as medically necessary when they correct a documented significant functional impairment and can be reasonably expected to improve that impairment. Reconstructive interventions are intended to address significant anatomic variation related to injury, disease, trauma, treatment, or congenital defect.

    Conversely, treatments intended primarily to preserve or improve appearance within the range of normal anatomic variation are defined as cosmetic and are generally not covered under the medical necessity criteria in this document.

    Definitions

    Functional impairment — examples
    Definition — scopeSignificant functional impairment may include physical, social, emotional, and psychological impairments or potential impairments.
    Examples — physical limitsProblems with communication, respiration, eating, swallowing, visual impairment, skin integrity, distortion of nearby body parts, or obstruction of an orifice.
    CausesMay result from pain, structural integrity issues, congenital anomalies, or other factors.
    Reconstructive — definition
    DefinitionProcedures intended to address significant variation from normal related to accidental injury, disease, trauma, treatment of a disease, or a congenital defect.
    GoalOften intended to restore the patient to whole or to correct functional/anatomic abnormality.

    Revision History & Policy Changes

    2026-01-06policy_effectiveLatest

    Policy effective date for the current revision cycle.

    2025-11-06revised

    Revised: Removed telangiectasia from the position statement section; revised formatting of Other Cosmetic Skin Procedures and Tattooing sections; updated Description, Rationale, Background, References and Websites; revised Coding section and removed CPT 36468.

    2021-05-13
    Policy Summary
    PayerAnthem
    PolicyCosmetic and Reconstructive Services: Skin Related
    Policy CodePolicy ANC.00007
    Change TypeRevised — coding and coverage updates
    Effective DateJan 6, 2026
    Last ReviewNov 6, 2025
    Next Review DateNov 6, 2025
    Key ActionVerify prior authorization and coding requirements for listed procedure codes and note removal of CPT 36468 before claim submission.
    SourceLink
    On This Page
    Coverage Criteria (Medically Necessary vs Cosmetic)Coding and Billing (CPT/ICD-10/Procedure Codes)Provider Actions, Documentation & Prior AuthorizationBackground and ScopeDefinitionsRevision History & Policy Changes
    • Include diagnosis codes for malignancy or history of breast cancer (eg, C50.xx, D05.xx, Z85.3) when applicable.
    • Reference breast reconstruction criteria per SURG.00023 when applicable and attach operative reports or consultation notes describing the reconstructive goal.
    Prior Authorization

    Conservative therapy expected prior to procedures

    Conservative (nonprocedural) therapy is generally expected and should be documented before pursuing procedural or surgical interventions for dermatologic conditions. Records should show trials of less invasive treatments, duration, and response prior to consideration of lasers, chemical peels, dermabrasion, microneedling, or surgical interventions.

    • For acne and rosacea: document trials of topical therapies (eg, retinoids, topical antibiotics, azelaic acid) and, if indicated, systemic antibiotics or isotretinoin with dates and outcomes (a typical trial period is ~12 weeks for topical therapies).
    • For actinic keratoses or pre-malignant lesions: document failure of topical retinoids, topical chemotherapeutic agents, and cryotherapy where medium/deep peels are considered.
    • When conservative therapy is not appropriate (for example, management of malignant lesions), document rationale for proceeding directly to procedural treatment.
    Denial Risk

    Cosmetic procedures lack medical necessity

    Services that are cosmetic and lack documentation of significant functional impairment or reconstructive intent are subject to denial. When codes map to position statements listed as cosmetic-only, include documentation that meets the medical necessity or reconstructive criteria to avoid denial.

    • Attach clinical notes demonstrating functional impairment or reconstructive purpose when billing codes that also appear in the cosmetic/not medically necessary lists.
    • If prior authorization is required by the member's benefit, obtain PA and submit supporting documentation and photos as indicated.
    Relation to medical necessityConsidered reconstructive when addressing significant anatomic variation with expectation of improving functional impairment.
    Cosmetic — definition
    DefinitionProcedures intended to change a physical appearance that would be considered within normal human anatomic variation.
    PurposePrimarily intended to preserve or improve appearance rather than to correct functional impairment.
    Examples (policy-noted)Treatment of photoaged skin, wrinkles, acne scarring, or uneven epidermal pigmentation when no functional impairment is present.
    Reconstructive — related policy (breast reconstruction)
    Cross-referenceReconstructive services may be separately addressed and referenced in other policies.
    Specific referenceSee SURG.00023 for breast reconstruction criteria.
    Note on benefitsNot all benefit contracts include reconstructive services; benefit language supersedes this document.
    revised

    Revised: Removed term 'physical' from 'physical functional impairment' in multiple position statements and updated Background, Definitions and References sections.

    2018-07-26revised

    Revised: Added microneedling as a cosmetic and not medically necessary indication and updated Background, References and Websites sections.

    2018-01-01coding_update

    Updated Coding section with 01/01/2018 CPT descriptor revision for CPT 36468.

    Policy number: ANC.00007. Publish date: 01/06/2026. Last review date recorded: 11/06/2025. Next review date listed: 11/06/2025.

    Scope summary: This document governs coverage of cosmetic, reconstructive, and medically necessary nonpharmacological skin procedures (for example, chemical peels, dermabrasion, lasers, hair procedures, and tattooing) for Anthem members. Benefit language may supersede the policy for reconstructive services.

    Related policies to consult include: ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck, CG-SURG-31 Treatment of Keloids and Scar Revision, CG-SURG-99 Panniculectomy and Abdominoplasty, CG-SURG-123 Autologous Fat Grafting and Injectable Soft Tissue Fillers, CG-SURG-127 Products for Wound Healing and Soft Tissue Grafting, MED.00132 Autologous Adipose-derived Regenerative Cell Therapy, and SURG.00023 Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures.