CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Fractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement

Defines coverage stance for fractional carbon dioxide (CO2) fractional ablative laser treatment of hypertrophic scars or keloids for functional improvement for BCBS Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyFractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionVerify member benefits and eligibility via the Benefit Booklet/Evidence of Coverage or provider call center.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredCoverage stance for fractional CO2 laser for functional improvement

2 codesSpecific codes identified as not covered

Jul 1, 2024Policy effective date

Feb 19, 2025Most recent review date

Coverage criteria and medical necessity

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Not medically necessary / Insufficient evidence

Covered when ALL of the following are met:

Coverage determination: Carbon dioxide (CO2) fractional laser ablation treatment of hypertrophic scars or keloids for functional improvement is not covered / not medically necessary due to insufficient evidence of improvement in net health outcomes

Commercial Products: not medically necessary; Medicare Advantage: CPT codes listed as not covered.

Evidence limitations: Systematic reviews and randomized controlled trials show very low to very uncertain certainty, with serious risk of bias, very serious imprecision, heterogeneity, and lack of functional outcome assessment

Review authors concluded evidence is insufficient to determine impact on scar severity or function; adverse events and functional outcomes largely not evaluated.

Coding and coverage implications: CPT Category III codes 0479T and 0480T for fractional ablative CO2 laser fenestration of burn and traumatic scars for functional improvement are not covered for Medicare Advantage Plans and are not medically necessary for Commercial Products

Claims for these codes will be denied as not covered / not medically necessary.

The following CPT codes are specified as not covered for Medicare Advantage Plans and as not medically necessary for Commercial Products: 0479T — Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first, and 0480T — Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof.

Carbon dioxide (CO2) fractional laser ablation treatment of hypertrophic scars or keloids for functional improvement is not medically necessary because the evidence is insufficient to determine its effects on health outcomes. Claims for the related CPT codes (0479T, 0480T) are therefore listed as not covered for Medicare Advantage and not medically necessary for Commercial Products.

Provider actions and billing notes

Note

Prior Authorization

Prior authorization is not applicable for this policy.

Note

Verify member benefits and eligibility

Providers must verify member-specific benefits and eligibility prior to providing services; benefits may vary by contract.

Verify member benefits and eligibility with the payer before scheduling or billing services.
Refer to the member's Evidence of Coverage, Subscriber Agreement, or employer agreement for coverage details.

Note

Provider action note

Providers should note important provider-impact information regarding benefits and billing.

Benefits may vary between groups and contracts; check the appropriate Benefit Booklet or Evidence of Coverage for physician-administered benefits.
Contact the BCBSRI provider call center for member-specific questions.

Denial Risk

Denial risk for listed CPT codes

Claims submitted with the CPT codes listed below are at risk for denial — they are not covered or are considered not medically necessary under this policy.

0479T - Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first — Not covered / Not medically necessary
0480T - Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children; Or part thereof — Not covered / Not medically necessary

Clinical background

Hypertrophic scars and keloids are raised cutaneous lesions that result from abnormal wound healing. Hypertrophic scars typically remain confined to the original injury site and may partially regress over time, whereas keloids extend beyond the original wound, are often refractory to treatment, and have high recurrence rates after excision. Management options are varied and include pharmacologic therapies, pressure or silicone therapy, surgery, radiation, and laser treatments. Fractional CO2 ablative lasers create microscopic thermal injuries that ablate the epidermis and remodel the dermis; they have been proposed to improve scar texture, thickness, and stiffness either as monotherapy or adjunctive therapy, but current evidence is limited regarding functional benefit.

Definitions and terminology

Fractional CO2 ablative laser — definition and mechanism

DefinitionFractional CO2 ablative laser: a laser technique that creates microscopic thermal wounds causing tissue vaporization and coagulation, ablating the epidermis and remodeling the dermis to improve scar texture, thickness, and stiffness.

Mechanism of actionCreates microscopic columns of thermal injury (fractional ablation) that vaporize tissue and coagulate surrounding extracellular proteins, allowing dermal remodeling while sparing surrounding skin.

Treatment intentProposed for improving appearance and functional impairment of hypertrophic scars and keloids by ablative destruction and resurfacing; may be used as monotherapy or adjunctively (e.g., sequential lasers or laser-assisted drug delivery).

Clinical advantagesAble to reach the dermis by ablating the epidermis while reducing complications seen with nonfractional ablative lasers.

Typical usesOriginally developed for cosmetic indications (photoaging, acne scarring) and applied to scars and keloids that impair function.

Hypertrophic scar vs keloid — distinguishing features

Hypertrophic scar — distributionRaised lesion confined to the limits of the original skin injury; may be linear (surgical/traumatic) or widespread (e.g., burn).

Hypertrophic scar — natural historyTends to regress spontaneously within about 1 year; immature hypertrophic scars may remodel and can be treated as linear hypertrophic scars if persistent beyond 1 month.

Keloid — distributionRaised, firm lesions that extend beyond the margins of the original injury onto normal tissue; classified as minor or major depending on size and extent.

Keloid — behavior and recurrenceDo not regress spontaneously, are often refractory to treatment, and have a high probability of recurrence after excision; higher prevalence in people of color.

Clinical implicationDistinction matters for prognosis and treatment selection because keloids are more persistent, prone to recurrence, and often more treatment-resistant than hypertrophic scars.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyFractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionVerify member benefits and eligibility via the Benefit Booklet/Evidence of Coverage or provider call center.

SourceLink

On This Page

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Fractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement

Coverage criteria and medical necessity

Coding and billing

Provider actions and billing notes

Clinical background

Definitions and terminology

0479T	Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first
0480T	Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children; Or part thereof