Cosmetic and Reconstructive Services: Skin Related
Governs coverage of cosmetic, reconstructive, and medically necessary nonpharmacological skin procedures (e.g., chemical peels, dermabrasion, lasers, hair procedures, tattooing) for Anthem members.
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.
Coverage Criteria (Medically Necessary vs Cosmetic)
inv-01: Chemical Peels - Medically Necessary Criteria
Covered when ALL of the following are met
inv-02: Vascular Lesions - Medically Necessary / Reconstructive Criteria
Covered when ALL of the following are met
inv-03: Dermabrasion - Medically Necessary Criteria
Covered when ALL of the following are met
inv-04: Hair Procedures - Medically Necessary Criteria
Covered when ALL of the following are met
inv-05: Rosacea - Medically Necessary Criteria
Covered when ALL of the following are met
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
Microneedling explicitly identified as cosmetic and not medically necessary.
inv-07: Tattooing and Tattoo Removal
See coding section for supporting ICD-10 diagnosis ranges for reconstructive indications (e.g., malignant neoplasm of breast).
inv-08: Tattooing — Medically Necessary vs Cosmetic
Tattooing (CPT 11920-11922) coverage logic:
Refer to the coding section for applicable ICD-10 diagnosis code ranges.
inv-09: Other Cosmetic Skin Procedures - Other skin procedures coverage logic
Other skin procedures coverage logic:
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)
| 15788-15789 | Chemical peel, facial |
| 15792-15793 | Chemical peel, nonfacial |
| 17106-17108 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique) |
| 15780-15782 | Dermabrasion |
| 15786-15787 | Abrasion (lesion) |
| 15783 | Dermabrasion; superficial, any site (eg, tattoo removal) |
| 96999 | Unlisted special dermatological service or procedure |
| 17999 | Unlisted procedure, skin, mucous membrane and subcutaneous tissue (laser skin resurfacing, tattoo removal, microneedling) |
| 11920-11922 | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation |
| C44.00-C44.99 | Basal cell, squamous cell, other or unspecified malignant neoplasm of skin |
| L57.0 | Actinic keratosis |
| L70.0-L70.9 | Acne |
| D18.00 | Hemangioma unspecified site |
| Q82.5 | Congenital non-neoplastic nevus |
| L71.0-L71.9 | Rosacea |
| C50.011-C50.929 | Malignant neoplasm of breast |
| 0HDSXZZ | Extraction of hair, external approach (ICD-10-PCS) |
| 0HRSX7Z | Replacement of hair with autologous tissue substitute, external approach (ICD-10-PCS) |
| 17999 | Unlisted procedure, skin, mucous membrane and subcutaneous tissue [when specified as laser skin resurfacing, tattoo removal (other than by dermabrasion), or microneedling] |
| 11920-11922 | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation |
| 3E00XMZ | Introduction of pigment into skin and mucous membranes, external approach |
| C50.011-C50.929 | Malignant neoplasm of breast (range) |
| C79.81 | Secondary malignant neoplasm of breast |
| D05.00-D05.92 | Carcinoma in situ of breast (range) |
| D48.60-D48.62 | Neoplasm of uncertain behavior of breast (range) |
| Z85.3 | Personal history of malignant neoplasm of breast |
| 36468 | Code removed from policy (no longer addressed) |
Provider Actions, Documentation & Prior Authorization
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 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.
- 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.
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.
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.
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
Revision History & Policy Changes
Policy effective date for the current revision cycle.
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.
Revised: Removed term 'physical' from 'physical functional impairment' in multiple position statements and updated Background, Definitions and References sections.
Revised: Added microneedling as a cosmetic and not medically necessary indication and updated Background, References and Websites sections.
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.
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