CurrentBlue Cross Blue Shield - MassachusettsPolicy 303

Ultrasonographic Evaluation of Skin Lesions

Policy governing the use of ultrasound to evaluate skin lesions, including assessment of margins, depth, and skin aging/rejuvenation, for commercial and Medicare members of Blue Cross Blue Shield - Massachusetts.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyUltrasonographic Evaluation of Skin Lesions

Policy CodePolicy 303

Change TypeAnnual literature review — no material changes

Effective Date

Next Review Date

Key ActionObtain precertification/preauthorization if the procedure is performed inpatient.

SourceLink

POLICY UPDATE CHANGES

Annual policy review updated literature through October 2022 with policy statements unchanged.

Policy 303internal policy identifier

Investigationalstance on ultrasonographic evaluation of skin lesions

Not medically necessarystance on use for photo-aging/skin rejuvenation

Precert required (inpatient)prior authorization requirement

No specific CPT code

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Coverage Criteria

Coverage stance — Covered when ALL of the following are met

Covered when ALL of the following are met

Investigational statement: Ultrasonographic evaluation of skin lesions is considered investigational due to insufficient evidence that its use improves health outcomes.

No qualifying clinical criteria provided; policy states investigational.

Cosmetic application: Ultrasonographic evaluation to assess photo-aging or skin rejuvenation techniques is considered cosmetic and not medically necessary.

Explicit noncoverage for cosmetic indication.

Ultrasonographic evaluation to assess photo‑aging or skin rejuvenation techniques is considered cosmetic in nature and is therefore NOT MEDICALLY NECESSARY. This policy applies to Commercial and Medicare products described in the policy scope.

Because these applications are cosmetic, claims for ultrasound imaging performed for the purpose of assessing photo‑aging or skin rejuvenation may be denied as not medically necessary.

Ultrasound skin imaging using high‑frequency transducers (≥20 MHz) to evaluate margins, depth, collagen distribution, or to characterize lesions is considered INVESTIGATIONAL due to insufficient evidence that its use improves patient health outcomes. The policy notes no identified studies demonstrating improved clinical outcomes (for example, reduced recurrence or improved survival) from preoperative ultrasonographic assessment of skin lesions.

Consequently, ultrasonographic evaluation of skin lesions for diagnostic or management decisions is considered not proven and may be noncovered; when used specifically to assess photo‑aging or skin rejuvenation it is explicitly classified as cosmetic and NOT MEDICALLY NECESSARY.

Coding

CPT CodesCPT

No codes listed

Provider Actions & Billing

Prior Authorization

Inpatient prior authorization required

Precertification/preauthorization is required for all products if the procedure is performed inpatient.

Applies to ALL products when service is performed as an inpatient procedure

Step Therapy

Step therapy

No step therapy requirements specified for this service.

Documentation Required

Coding and contract documentation

Providers should document and report services using up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers as appropriate. Verify member contract benefits at time of service to determine coverage or non-coverage.

Background

High‑frequency ultrasound (transducers of at least 20 MHz) has been proposed for several dermatologic uses, including assessing margins and depth of melanoma and non‑melanoma skin cancers to aid surgical planning, monitoring connective tissue skin diseases (for example, evaluating collagen amount and location in scleroderma), assessing actinic keratoses to guide treatment, and evaluating inflammatory skin diseases such as allergic reactions or psoriasis.

The available evidence is insufficient to show that using ultrasound for these indications leads to improved health outcomes. No studies were identified that demonstrated benefits such as reduced recurrence rates or improved survival when ultrasound was used preoperatively. For these reasons the technology is considered investigational for evaluation of skin lesions, and its use for cosmetic assessment of photo‑aging or skin rejuvenation is considered not medically necessary.

Definitions

Ultrasonographic evaluation (>=20 MHz) — definition and scope

DefinitionUse of ultrasound transducers (at least 20 MHz) to assess margins and depth of melanoma and non-melanoma skin cancers, follow connective tissue skin diseases by evaluating collagen amount/location in the dermis, assess actinic keratoses for treatment planning, and assess inflammatory skin diseases to inform management decisions.

Transducer requirementUltrasound transducers of at least 20 MHz are used for these evaluations.

Clinical applicationsAssess margins and depth to aid surgical planning; follow connective tissue skin diseases (e.g., scleroderma) by evaluating dermal collagen; assess actinic keratoses to determine appropriateness of cryosurgery; assess inflammatory skin diseases (e.g., allergic reactions, psoriasis).

Coverage stanceConsidered investigational due to insufficient evidence that use improves health outcomes.

Cosmetic useUse to assess photo‑aging or skin rejuvenation techniques is considered cosmetic and not medically necessary.