Fractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement
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Policy governing coverage and medical necessity determination for fractional carbon dioxide (CO2) fractional ablative laser treatment of hypertrophic scars or keloids intended to provide functional improvement, applicable to Medicare Advantage and Commercial products.
No material clinical or coverage changes in this revision.
Coverage Determination and Criteria
Overall coverage determination
Covered when ALL of the following are met:
Evidence includes randomized controlled trials, nonrandomized studies, and systematic reviews with overall very low certainty, serious imprecision, risk of bias, heterogeneity across studies, and a lack of evaluated functional outcome measures.
The use of CPT codes 0479T and 0480T applies specifically to fractional ablative laser fenestration of burn and traumatic scars for the purpose of functional improvement. These codes are listed in this policy as not covered for Medicare Advantage Plans and not medically necessary for Commercial Products. Providers should not bill these codes expecting coverage under the positions stated in this document.
This medical policy is provided for informational purposes and is not a guarantee of payment. Coverage and eligibility are determined by the member's subscriber agreement, member certificate, or employer agreement, which supersede this policy. For member-specific benefits, providers must contact the provider call center or refer to the member’s Benefit Booklet, Evidence of Coverage, or Subscriber Agreement.
For Commercial Products, carbon dioxide (CO2) fractional laser ablation treatment of hypertrophic scars or keloids when performed for functional improvement is considered not medically necessary because the evidence is insufficient to determine its effects on health outcomes.
For Medicare Advantage Plans, carbon dioxide (CO2) fractional laser ablation treatment of hypertrophic scars or keloids for functional improvement is not covered due to insufficient evidence to determine the impact on health outcomes.
Coding and Billing
| 0479T | Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part thereof, or 1% of body surface area of infants and children |
| 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 |
Provider Responsibilities and Billing Implications
Confirm prior authorization requirements with BCBSRI
This policy is informational; providers should verify member-specific prior authorization requirements with BCBSRI because benefits and participation agreements determine authorization needs.
- Verify prior authorization requirements with BCBSRI for the individual member.
Document coding and clinical rationale
Document coding and clinical rationale accurately and follow member-specific coverage terms; the policy lists the CPT codes for fractional ablative CO2 laser fenestration as not covered or not medically necessary.
- Ensure submitted codes reflect the service performed and align with this policy's coding guidance.
- Include clinical documentation showing medical necessity per the member's benefit documents when applicable.
Verify coverage and obtain member consent when necessary
Before delivering or billing for fractional CO2 ablative laser procedures, verify member coverage and obtain any required member consent if services may be non-covered or not medically necessary.
- Obtain written member agreement in advance if charging for services that may be non-covered.
- Confirm applicability of this policy to the member's benefits.
Check member Benefit Booklet / EOC / Subscriber Agreement
Benefits can vary by group or contract; refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement to determine applicable coverage details.
- Check the member's Benefit Booklet / Evidence of Coverage / Subscriber Agreement for coverage specifics.
Contact provider call center for member-specific benefits/eligibility
For member-specific benefits and eligibility, contact the BCBSRI provider call center because benefits and eligibility are determined by the member's subscriber or employer agreement which supersedes this policy.
- Call the provider call center for member-level benefits and eligibility determinations.
Financial risk if service deemed not medically necessary
If services are determined not medically necessary, providers may be unable to bill the member unless the member was informed and agreed in writing in advance to pay for the service.
- Obtain written advance agreement from the member before providing services that may be non-covered if you intend to bill them.
- Refer to participation agreement provisions for applicable billing rules.
Clinical Background
Hypertrophic scars and keloids are abnormal wound‑healing cutaneous lesions that differ in behavior and prognosis. Hypertrophic scars are raised lesions that remain within the original injury limits and may regress over time, whereas keloids extend beyond the original injury margins and are often refractory to treatment with a high recurrence rate after excision. Fractional CO2 ablative laser therapy creates microscopic thermal injuries that ablate epidermis and reach the dermis, a technique proposed to remodel scar tissue and improve texture, thickness, and stiffness; it may be used alone or as an adjunct to other therapies.
Key Terms and Definitions
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