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    v1.0.28
    OpenPayerPolicy UpdatesDermatologyAnthem Pre-Malignant Lesion Coverage | OpenPayer
    Ask Trek AI about this page
    CurrentAnthemPolicy CG-SURG-37

    Destruction of Pre-Malignant Skin Lesions

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    Addresses local destruction of qualifying pre-malignant skin lesions using techniques such as laser surgery, electrosurgery, cryosurgery, chemosurgery, and surgical curettement; excludes benign or malignant lesions, laser resurfacing, surgical excision, and specified lesions treated without local destruction.

    Policy Summary
    PayerAnthem
    PolicyDestruction of Pre-Malignant Skin Lesions
    Policy CodePolicy CG-SURG-37
    Change TypeAdministrative and editorial updateno material coverage change
    Effective DateOct 1, 2026
    Last ReviewAug 13, 2026
    Next Review DateN/A
    Key ActionConfirm that the lesion is a qualifying pre-malignant condition and that treatment uses an accepted local destruction technique.
    SourceLink
    POLICY UPDATE CHANGES

    The 2026 revision added a new Members and Families summary section.

    The 2026 revision changed the terminology from “Bowen’s disease” to “Bowen disease” throughout the document.

    The 2026 revision updated formatting in the Clinical Indications section and revised descriptive, discussion, definition, reference, and website sections.

    3Qualifying pre-malignant lesion categories
    5+Local destruction techniques described
    11Non-qualifying lesion examples

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    3CPT destruction codes listed

    Medical Necessity and Scope

    Medically Necessary Local Destruction

    Covered as medically necessary when ALL of the following are met:

    Medical necessity

    • Service: The service is destruction of a pre-malignant skin lesion using local destruction, such as laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement, or another local destruction technique.

    • Qualifying lesion

      • Actinic keratosis.
      • Lentigo maligna.
      • Squamous cell carcinoma in situ (Bowen disease).

    The guideline does not address benign or malignant skin lesions. Local destruction of these lesions is therefore outside the scope of this guideline.

    The guideline does not address laser skin resurfacing or surgical excision. These services fall outside the scope of the local-destruction criteria described here.

    Pre-malignant lesions that are not removed using local destruction techniques are outside the guideline. Examples include Nevus Sebaceous of Jadassohn and Giant Blue Nevus.

    The following lesions do not qualify as pre-malignant under the guideline: acrochordons (skin tags), cherry angioma, dermatofibroma, hemangioma (superficial or deep), neurofibroma, nevus flammeus (port-wine stain), nevus simplex, pyogenic granuloma, seborrheic keratosis, telangiectasia, and verruca vulgaris (warts).

    Local destruction is not clinically appropriate for scenarios other than the listed pre-cancerous lesions: actinic keratosis, lentigo maligna, and squamous cell carcinoma in situ (Bowen disease). Unnecessary or unproven treatment may result in inappropriate care and anxiety.

    Covered Procedure and Diagnosis Codes

    Covered CPT CodesCPTCovered
    17000Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion.
    17003Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each.
    17004Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); 15 or more lesions.
    Covered ICD-10 Diagnosis CodesICD-10Covered
    D03.0-D03.9Melanoma in situ.
    D04.0-D04.9Carcinoma in situ of skin.
    L57.0Actinic keratosis.

    Provider Decision Points

    Denial Risk

    Confirm the lesion qualifies before destruction

    Do not perform or bill local destruction when the lesion is not one of the listed pre-malignant conditions. Destruction is not clinically appropriate for lesions such as skin tags, cherry angioma, dermatofibroma, hemangioma, neurofibroma, port-wine stain, nevus simplex, pyogenic granuloma, seborrheic keratosis, telangiectasia, or common warts.

    • Confirm that the lesion is a qualifying pre-malignant condition before providing local destruction.
    • The guideline lists actinic keratosis, lentigo maligna, and squamous cell carcinoma in situ (Bowen disease) as qualifying conditions.
    Denial Risk

    Use an in-scope treatment and indication

    Verify that the service falls within this guideline’s scope. Services involving benign or malignant lesions, laser skin resurfacing, surgical excision, or pre-malignant lesions treated by methods other than local destruction fall outside the guideline.

    • Covered local destruction techniques include laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement, and similar local destruction techniques.

    Clinical Background

    Pre-malignant skin lesions may develop after long-term sun or ultraviolet exposure and may progress to skin cancer if untreated. Actinic keratosis is a common pre-malignant lesion that may progress to squamous cell carcinoma, while lentigo maligna may progress to invasive melanoma. Local destruction methods described in the guideline include laser surgery, electrosurgery, cryosurgery, chemosurgery, and surgical curettement.

    Key Terms

    Actinic keratosis
    DefinitionA rough, scaly patch or growth that forms on the skin after damage from the sun or ultraviolet light.
    Bowen disease
    DefinitionA flat, reddish, scaly patch that grows slowly on the skin and is considered a precursor to squamous cell carcinoma.
    Skin tag
    DefinitionA small, soft, pendulous growth on the skin.
    Wart
    Definition
    Policy Summary
    PayerAnthem
    PolicyDestruction of Pre-Malignant Skin Lesions
    Policy CodePolicy CG-SURG-37
    Change TypeAdministrative and editorial updateno material coverage change
    Effective DateOct 1, 2026
    Last ReviewAug 13, 2026
    Next Review DateN/A
    Key ActionConfirm that the lesion is a qualifying pre-malignant condition and that treatment uses an accepted local destruction technique.
    SourceLink
    On This Page
    Medical Necessity and ScopeCovered Procedure and Diagnosis CodesProvider Decision PointsClinical BackgroundKey Terms
  1. Pre-malignant lesions not removed using local destruction techniques, such as Nevus Sebaceous of Jadassohn or Giant Blue Nevus, are not included in the listed pre-malignant conditions.
    2. A non-cancerous growth on the skin that appears when a virus affects the top layer of the skin.