Laser Treatment for Proliferative Vascular Lesions
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This policy governs medical coverage for laser treatment of port-wine stains, hemangiomas, and superficial vascular malformations for Blue Cross Blue Shield - Rhode Island commercial products and Medicare Advantage plans, specifying when treatment is medically necessary versus cosmetic.
No material clinical or coverage changes in this revision.
Coverage Criteria
Medically Necessary Indications
Covered when ANY of the following are met for vascular lesions (port‑wine stains, hemangiomas, superficial vascular malformations):
Applies to Commercial Products; Medicare Advantage requires meeting online authorization tool criteria.
Applies to Commercial Products; Medicare Advantage requires meeting online authorization tool criteria.
Cosmetic / Not Covered
Not covered when:
These procedures are considered cosmetic and are not covered for Commercial Products.
Clinical Considerations
Clinical guidance / limits:
Deep lesions that require surgery are not addressed by this laser policy and are considered separately under surgical benefits when surgery is indicated.
Consider non‑laser therapies (eg, systemic or intralesional corticosteroids) for complicated hemangiomas per clinical judgment prior to or in conjunction with laser when appropriate.
This policy does not address deep, structural lesions that require surgical treatment; such deep lesions are considered medically necessary when surgery is indicated and are covered under surgical benefits. The policy specifically addresses laser treatment of port‑wine stains, hemangiomas, and superficial vascular malformations only and excludes management of deep or structural vascular lesions that need operative intervention.
Laser treatment of port‑wine stains, hemangiomas, or superficial vascular malformations performed solely to alter or enhance appearance that does not interfere with physical body function is considered cosmetic and is not covered for Commercial Products. Coverage for medically necessary indications applies only when the clinical criteria in the policy are met.
Coding
| 17106 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm |
| 17107 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm |
| 17108 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm |
| 17106 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm |
| 17107 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm |
| 17108 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm |
Provider Actions & Authorization
Obtain prior authorization via online tool (Medicare Advantage required; Commercial recommended)
Prior authorization must be obtained via the online authorization tool for participating providers: it is required for Medicare Advantage Plans and recommended for Commercial Products when submitting CPTs 17106, 17107, or 17108 for consideration as medically necessary.
Submit authorization requests through online tool and meet tool criteria
Use the online authorization tool and meet the online tool’s medical criteria before performing or billing for laser treatment of proliferative vascular lesions; failure to follow the tool’s requirements may prevent consideration of the CPTs as medically necessary.
Use the online authorization tool for participating providers
Participating providers must use the online authorization tool; prior authorization is required for Medicare Advantage and is recommended for Commercial Products.
- Medicare Advantage: prior authorization required via the online tool for participating providers.
- Commercial Products: use of the online tool is recommended.
Do not bill for cosmetic-only procedures (not covered)
Do not perform laser procedures solely to alter or enhance appearance when the lesion does not interfere with physical body function—these are considered cosmetic and are not covered.
- Laser treatment intended only to improve appearance for port-wine stains, hemangiomas, or superficial vascular malformations that do not affect function is excluded from coverage.
Risk of denial without prior authorization (Medicare Advantage required)
Lack of prior authorization for Medicare Advantage may result in claim denial; prior authorization is required for Medicare Advantage and recommended for Commercial Products via the online tool.
Background
Port‑wine stains, hemangiomas, and other vascular birthmarks vary by type, depth, and location. Port‑wine stains (proliferative vascular lesions) typically begin as pink macules and can darken and thicken over time, commonly appearing on the face and neck. Hemangiomas and vascular malformations may be superficial or deep; many hemangiomas involute over years while deep or structural malformations may require surgical management. This policy focuses on laser treatment for superficial lesions (port‑wine stains, hemangiomas, and superficial vascular malformations) and does not address deep lesions that need surgery.
Definitions
Revision History
Policy last reviewed on 06/03/2026 per document header.
Effective date for Medicare Advantage coverage of CPT codes 17106, 17107, and 17108 set to 10/1/2025.
Policy noted in Provider Update published December 2024.
Policy referenced in Provider Update published April 2023.
Policy referenced in Provider Update published June 2022.
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