CurrentBaylor Scott & White Health PlanPolicy 049

Dermatoscopy

This policy governs the medical coverage stance for dermatoscopy and related noninvasive skin imaging technologies for Baylor Scott & White Health Plan members across applicable lines of business in North Carolina and other plan service areas. It explains which techniques are considered incidental, not separately reimbursable, or unproven.

Policy Summary

PayerBaylor Scott & White Health Plan

PolicyDermatoscopy

Policy CodePolicy 049

Change TypeRoutine review — no material changes

Effective Date03/01/2026

Next Review Date02/26/2027

Key ActionDo not separately bill for dermatoscopy; document benefits in the member's Evidence of Coverage or Summary Plan Description and verify coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

049Policy number

03/01/2026Effective

02/26/2026Last review

02/26/2027Next review

96931-96936,96904Codes not covered

Coverage stance and criteria

Coverage stance

Policy coverage stance and conditions

Coverage stance: BSWHP considers dermatoscopy incidental to a dermatologic exam and not separately reimbursable; there is no established code for dermatoscopy.

Providers should review plan EOC or SPD for benefit coverage; medical necessity as defined by this policy does not ensure the benefit is covered.

Technologies considered unproven (not medically necessary)

Reflectance/confocal modalities: Confocal microscopy, multi-photon laser scanning microscopy, and reflectance confocal microscopy are considered unproven because clinical value has not been established.
Multispectral analysis: Multispectral digital skin lesion analysis is considered unproven because clinical value has not been established.

Policy Summary

PayerBaylor Scott & White Health Plan

PolicyDermatoscopy

Policy CodePolicy 049

Change TypeRoutine review — no material changes

Effective Date03/01/2026

Next Review Date02/26/2027

Key ActionDo not separately bill for dermatoscopy; document benefits in the member's Evidence of Coverage or Summary Plan Description and verify coverage.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider requirements, billing and denial risk

Prior Authorization

Prior authorization

Prior authorization: Not applicable.

Note

Documentation Required

Documentation / plan verification

Review the member's Evidence of Coverage (EOC) or Summary Plan Description (SPD) to verify whether dermatoscopy or related imaging services are a covered benefit for the specific plan. Confirm medical necessity per the policy definition and any applicable plan or payer-specific rules; medical necessity determination does not guarantee coverage if the service is excluded by the member's benefit plan.

Billing Rule

Billing / denial triggers for listed CPT codes

Billing/denial triggers: Dermatoscopy is considered incidental to the dermatologic exam and not separately reimbursable when performed by standard dermatoscopy methods; there is no established separate code. Reflectance confocal microscopy and whole body integumentary photography are listed as not covered. Submit claims using appropriate CPT/diagnosis codes only when plan documents allow separate reimbursement. Expect denials when billing the following CPT codes for separate reimbursement:

CPT 96931 - Reflectance confocal microscopy, head/neck
CPT 96932 - Reflectance confocal microscopy, trunk, arms, legs
CPT 96933 - Reflectance confocal microscopy, multiple lesions (list as per payer)
CPT 96934 - Reflectance confocal microscopy, repeat or follow-up (as applicable)
CPT 96935 - Reflectance confocal microscopy, additional services
CPT 96936 - Reflectance confocal microscopy, other (as applicable)
CPT 96904 - Whole body integumentary photography

Background on dermatoscopy and imaging

Dermatoscopy (also called dermoscopy or epiluminescence microscopy) is a family of noninvasive techniques for in vivo visualization of epidermal and epidermal–dermal junction structures to help distinguish benign from malignant pigmented lesions. Methods include handheld or stereomicroscopic inspection, immersion techniques, image digitization, and computer-assisted analysis for storage and comparison. Additional imaging modalities described in the literature include reflectance confocal microscopy, multi-photon laser scanning microscopy, multispectral digital skin lesion analysis, and optical coherence tomography; however, BSWHP considers several of these—specifically confocal microscopy, MSDSLA, and OCT—to have inadequate evidence to establish clinical benefit.

Definitions of terms and modalities

inv-10: Dermatoscopy — definition and key points

DefinitionNoninvasive in vivo microscopic examination of skin lesions using immersion techniques and magnification to visualize structures of the epidermis and epidermal-dermal junction; may use handheld or stereomicroscope and digitization for storage and comparison.

PurposeIntended to help distinguish benign from malignant pigmented skin lesions and support decisions about biopsy or excision.

Technique detailsInvolves application of immersion oil to eliminate surface reflection and visualization of features (eg, pseudopods, radial streaming, pigment network patterns) often organized into diagnostic algorithms.

LimitationsLiterature is inconclusive regarding clinical impact on management and there is inadequate documentation of clinical value in various situations.

inv-11: Multispectral digital skin lesion analysis (MSDSLA) — device description and algorithm-based classification

Device descriptionDevices illuminate suspicious lesions with multiple visible wavelengths (ten wavelengths) that can penetrate up to about 2.5 mm beneath the skin surface; reflected light is captured and analyzed by a data processor.

Algorithm-based classificationProprietary computer algorithms evaluate lesion characteristics and classify lesions as positive (high morphologic disorganization) or negative (low morphologic disorganization); positive lesions are recommended for biopsy.

Policy stanceBSWHP considers multispectral digital skin lesion analysis unproven because its clinical value has not been established.

inv-12: Optical coherence tomography (OCT) — definition and imaging characteristics

DefinitionA noninvasive imaging technology that utilizes reflected light to produce cross-sectional subcutaneous images of tissue at a resolution equivalent to a low-power microscope.

Imaging characteristicsProduces microstructural and morphological tissue imagery at higher resolution than MRI or ultrasound, enabling visualization of subsurface skin morphology.

Policy stanceBSWHP considers optical coherence tomography unproven because its clinical value has not been established.

inv-13: Reflectance confocal microscopy (and related modalities) — laser-based imaging definition and policy stance

DefinitionLaser-based imaging in which a laser beam is projected onto the skin and reflected light is detected and recorded to produce images; similar in principle to dermatoscopy but uses confocal laser technology.

Related modalitiesIncludes reflectance confocal microscopy and multiphoton laser scanning microscopy that generate high-resolution images of skin architecture.

Policy stanceReflectance confocal microscopy and related laser-based modalities are considered unproven by BSWHP because clinical value has not been established; direct billing for listed confocal CPT codes may be denied.

OpenPayer

Dermatoscopy

Coverage stance and criteria

CPT / Coding guidance

Provider requirements, billing and denial risk

Background on dermatoscopy and imaging

Definitions of terms and modalities

96931-96936	Reflectance confocal microscopy
96904	Whole body integumentary photography