Laser Treatment of Skin Lesions
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Defines medical necessity, prior authorization, and coverage criteria for laser therapy for various skin lesions for Baylor Scott & White Health Plan members; applies across lines of business and references Medicare and Texas Medicaid guidance where applicable.
No material clinical or coverage changes in this revision.
Coverage Criteria
Conditions considered medically necessary
BSWHP may consider laser therapy medically necessary for ONE or more of the following conditions:
Consultation with a hemangioma specialist is required
Cosmetic (Not covered)
Laser therapy is considered cosmetic for the following conditions (list is NOT inclusive):
Cosmetic treatments are generally not a benefit for many plans.
Experimental / Investigational
Many skin lesions are considered cosmetic and, as such, treatment with laser therapy is often not a benefit under many plans. The policy lists common cosmetic indications (not inclusive) that are excluded from coverage; providers should verify plan-specific benefit language in the member’s Evidence of Coverage or Summary Plan Description before requesting services.
Laser therapy for the conditions listed as cosmetic in this policy is considered not medically necessary and is generally not covered. Examples of such cosmetic indications include dyschromia, hair removal for pseudofolliculitis barbae, spider angiomata, telangiectasias in adults, rosacea, acne, granuloma faciale, rhinophyma, genital warts, superficial glomangiomas, pyogenic granuloma, and verrucae; this list is not exhaustive.
Coding
| 17106 | Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); less than 10 sq cm |
| 17107 | Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); 10.0 to 50.0 sq cm |
| 17108 | Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); over 50.0 sq cm |
| D18.00 - D18.09 | Hemangioma |
| L40.0 | Psoriasis vulgaris (plaque psoriasis) |
| L91.0 | Hypertrophic scar (keloid) |
| Q82.5 | Congenital non-neoplastic nevus (Port wine stain) |
Provider Actions & Requirements
Prior authorization required
Prior authorization is required for laser treatment of skin lesions; review the member's plan EOC/SPD for coverage details and applicable Medicare/Medicaid guidance before proceeding.
- Policy header: PRIOR AUTHORIZATION: Required
- Recommendation to review plan EOC/SPD and applicable NCD/LCD or Medicaid TMPPM guidance
Topical therapy failure required prior to laser
For mild to moderate localized plaque psoriasis, laser therapy is covered only when the condition affects 10% or less of body area AND the member has failed to adequately respond to 3 or more months of topical treatments.
- Must have failed ≥3 months of topical treatments before laser is considered
- Applies when disease affects ≤10% of body surface area
Coding and documentation note
Document the CPT procedure code(s) and applicable ICD-10 diagnosis code(s) and confirm the member meets the policy's clinical criteria; inclusion of a code in the policy does not guarantee reimbursement.
Denial risk if prior authorization not obtained
Failure to obtain prior authorization when required may result in denial of service.
Background
Lasers produce high-intensity light generated within a medium (gas, liquid/dye, or solid) that determines the device’s specific wavelength. Clinical effects depend on the device’s wavelength, pulse duration, and the target tissue’s light absorption characteristics; these parameters determine whether the laser will cut, coagulate, seal, or otherwise alter tissue. Because different media produce different wavelengths (visible or infrared), device selection must match the clinical target and desired tissue response.
Definitions
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