ModifiedCignaPolicy N/A

Excimer Laser, Dermabrasion and Chemical Peels for Dermatologic Conditions

Covers Cigna's coverage stance and medical necessity criteria for office-based targeted excimer laser therapy (308 nm), dermabrasion, and chemical peels for various dermatologic conditions for adult and pediatric populations.

Policy Summary

PayerCigna

PolicyExcimer Laser, Dermabrasion and Chemical Peels for Dermatologic Conditions

Policy CodePolicy N/A

Change TypeRevisions and content migrationmaterial updates to phototherapy/excimer and dermabrasion/peel statements

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization when required and document trials of recommended topical/field therapies and diagnosis linkage (eg, actinic keratosis for dermal procedures) to support medical necessity.

SourceLink

POLICY UPDATE CHANGES

Revised the policy statements for phototherapy, photochemotherapy, and excimer laser therapy.

Added policy statements for continuation of coverage for phototherapy, photochemotherapy, and excimer laser therapy.

Removed the policy statement for home phototherapy devices.

Content from CP 0505 Dermabrasion and Chemical Peels moved into this CP and title changed; policy statements for dermabrasion, microdermabrasion, dermal and epidermal chemical peels were revised.

Removed policy statements for phototherapy and photochemotherapy (in a prior revision).

308 nmwavelength

>=10diffuse lesion threshold

psoriasis & vitiligoprimary indications

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

CP 0505merged content

home phototherapypolicy removal

Coverage Criteria

Plaque Psoriasis

Covered when ALL of the following are met

Psoriasis - initial therapy: Office-based targeted excimer laser therapy (308 nanometers) is medically necessary for localized, plaque psoriasis refractory to conservative treatment with topical agents and/or phototherapy.

Plaque Psoriasis — continuation

Covered when ALL of the following are met

Psoriasis - continuation: Continued office-based targeted excimer laser therapy (308 nanometers) is medically necessary when initial criteria are met and there is a beneficial clinical response to treatment.

Vitiligo

Covered when ALL of the following are met

Vitiligo - prerequisites: Failure, intolerance or contraindication to a twelve consecutive week trial of at least ONE topical corticosteroid.12 weeks

Vitiligo - prerequisites: Failure, intolerance or contraindication to a twelve consecutive week trial of at least ONE topical calcineurin inhibitor (e.g., tacrolimus 0.03% or 0.1% ointment, pimecrolimus 1% cream).12 weeks

Vitiligo - continuation: Continued office-based targeted excimer laser therapy (308 nanometers) is medically necessary when there is a beneficial clinical response to treatment.

Dermabrasion and Dermal Chemical Peels for Actinic Keratoses

Covered when ALL of the following are met

Diffuse lesions: Lesions are diffuse (e.g., ≥ 10 lesions) making targeted therapy impractical.≥ 10 lesions

Prior field therapy failure: Failure, contraindication or intolerance to one or more conventional field therapy treatments (e.g., topical 5-fluorouracil, topical diclofenac, photodynamic therapy, topical imiquimod).

Applies to CPTs 15780-15782 and 15789,15793 when coverage available.

Coverage positions

Coverage stance drawn from evidence summaries in this section:

General — excimer/phototherapy for listed other conditions: Excimer laser therapy and other phototherapies are considered not established/insufficient evidence for the listed conditions (alopecia areata, atopic dermatitis, cicatricial alopecia, chronic vesicular dyshidrotic eczema, diabetic foot ulcer, generalized granuloma annulare, lichen planus, herpesviridae, onychomycosis, psoriatic nail disease, uremic pruritus).

Most studies are case series, retrospective reviews, small RCTs, heterogeneous in design and short-term follow-up.

Onychomycosis — mixed evidence: Systematic reviews/meta-analyses report heterogeneous results; one meta-analysis reported overall mycological cure ~63% across lasers but RCT quality and heterogeneity limit conclusions.

Evidence limited to few RCTs and variable protocols; not definitive.

Dermabrasion/chemical peels for actinic keratoses: Dermabrasion and chemical peels may be considered accepted/established treatment options for multiple or diffuse actinic keratoses as part of lesion-directed or field therapy.

Dermabrasion not listed as accepted for squamous cell carcinoma in situ (Bowen's disease).

Medical necessity for dermal procedures

Covered when ALL of the following are met

Primary coverage criteria for dermal dermabrasion and dermal chemical peels: Procedure is dermal-depth dermabrasion (CPT 15780-15782) or dermal chemical peel (CPT 15789, 15793) AND diagnosis is actinic keratosis (ICD-10 L57.0) AND applicable policy statements/criteria are satisfied; typically reserved for multiple/recalcitrant AK (e.g., >10 lesions) or diffuse severe actinic damage where field therapy is appropriate.

When billed, dermal-depth dermabrasion and dermal chemical peels require an associated diagnosis of actinic keratosis (L57.0).

Field therapy criteria

Covered when ALL of the following are met

Use of dermabrasion/medium-deep peels as field therapy: Medium and deep chemical peels and dermabrasion may be considered accepted field therapies for treatment of numerous (eg, >10) recalcitrant actinic keratoses when other field therapies have failed or are impractical.

Documentation should reflect number and distribution of AK lesions (e.g., >10, diffuse severe actinic damage) and intent (lesion-directed vs field therapy) to support medical necessity rather than cosmetic purpose.

Targeted excimer laser therapy (308 nm) is not medically necessary for indications other than those specifically listed as covered (plaque psoriasis and vitiligo). The policy lists multiple dermatologic conditions for which excimer therapy is considered not medically necessary, including but not limited to alopecia areata, atopic dermatitis, cicatricial alopecias, cutaneous herpes virus, chronic ordinary urticaria, diabetic foot ulcer, dyshidrotic eczema, granuloma annulare, lichen planus, onychomycosis, psoriatic nail disease, pityriasis rosea, prurigo nodularis, and urticaria pigmentosa. Requests for excimer laser for these indications should be expected to be denied as not medically necessary unless documentation demonstrates a covered indication.

Dermabrasion performed solely to improve appearance is considered cosmetic and not medically necessary. This includes dermabrasion procedures used for acne scarring, tattoo removal, fine wrinkles, or other interventions intended solely to alter appearance rather than to treat a functional or precancerous lesion. Specifically, dermabrasion of any type (CPTs 15780, 15781, 15782) for indications not listed as covered and microdermabrasion or superficial dermabrasion (CPT 15783) are excluded from coverage when used for cosmetic purposes.

Procedures performed solely for cosmetic purposes are excluded from coverage. Examples of cosmetic-only indications include treatment of photo-aged skin, rhytids/wrinkles, uneven pigmentation, scar revision, rosacea, rhinophyma, and tattoo removal. Superficial dermabrasion/microdermabrasion, superficial/epidermal chemical peels (CPTs 15788, 15792), and chemical exfoliation for acne (CPT 17360) are considered cosmetic and not covered or reimbursable when provided for these purposes.

The policy statement addressing home phototherapy devices has been removed. As a result, coverage determinations should not rely on a prior home phototherapy provision; providers should follow the current policy statements and prior authorization requirements for office-based phototherapy and excimer laser therapy.

Targeted excimer laser therapy (308 nm) is considered not medically necessary in any setting for indications beyond the covered uses of localized plaque psoriasis and vitiligo. The policy explicitly lists multiple noncovered conditions and clarifies that excimer therapy is limited to the specified covered indications.

Excimer laser therapy and other phototherapy modalities are considered not established/insufficient evidence for a range of other dermatologic conditions. The published literature is primarily small case series, retrospective reviews, and a few small randomized trials with heterogeneous methods and short follow-up; outcomes are inconsistent or conflicting. Examples of conditions with insufficient evidence include alopecia areata, atopic dermatitis, generalized granuloma annulare, onychomycosis, and psoriatic nail disease. Requests for these indications may be denied due to lack of demonstrated safety and efficacy as monotherapy in peer-reviewed studies.

Dermabrasion and chemical peels performed to improve appearance are considered cosmetic and not medically necessary. Superficial chemical peels (epidermal peels) and microdermabrasion used for anti-aging, treatment of mild photoaging, acne, rhytids, uneven pigmentation, or tattoo removal are excluded from coverage. Dermal chemical peels (CPTs 15789, 15793) and dermal-depth dermabrasion (CPTs 15780–15782) may be covered only when criteria are met (for example, treatment of actinic keratoses with appropriate documentation); otherwise, procedures intended solely for cosmetic improvement will be denied.

Coding

Dermabrasion, chemical peels, and chemical exfoliation CPT codesCPT

15780	Dermabrasion
15781	Dermabrasion
15782	Dermabrasion
15783	Microdermabrasion or superficial dermabrasion
15788	Epidermal chemical peel
15789	Dermal chemical peel
15792	Epidermal chemical peel
15793	Dermal chemical peel
17360	Chemical exfoliation

Dermabrasion, chemical peels, and chemical exfoliation CPT codes (alternate listing)CPT

No codes listed

Considered medically necessary when policy criteria metCPTCovered

96920	Excimer laser treatment for psoriasis; total area less than 250 sq cm
96921	Excimer laser treatment for psoriasis; 250 sq cm to 500 sq cm
96922	Excimer laser treatment for psoriasis; over 500 sq cm

Dermabrasion (covered with criteria)CPTCovered

15780	Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)
15781	Dermabrasion; segmental, face
15782	Dermabrasion; regional, other than face

Dermabrasion - Not CoveredCPTNot Covered

15783

Dermabrasion; superficial, any site (eg, tattoo removal)

Chemical peel - dermal (covered with criteria)CPTCovered

15789	Chemical peel, facial; dermal
15793	Chemical peel, nonfacial; dermal

Chemical peel - epidermal / acne exfoliation (Not Covered)CPTNot Covered

15788	Chemical peel, facial; epidermal
15792	Chemical peel, nonfacial; epidermal
17360	Chemical exfoliation for acne (eg, acne paste, acid)

Diagnosis codes linked to covered proceduresICD-10

L57.0

Actinic keratosis

Diffuse lesions threshold

Diffuse lesions thresholdLesions are diffuse (e.g., ≥ 10 lesions) making targeted therapy impractical.

Example applicationUsed to define when dermabrasion (CPT 15780-15782) or dermal chemical peels (CPT 15789,15793) may be considered for actinic keratoses.

Implication for documentationNumber and distribution of AK lesions (e.g., >10) should be recorded to support field therapy intent rather than cosmetic indication.

Provider Actions and Billing Guidance

Billing Rule

Coding and Submission Requirements

Providers must review applicable benefit plan documents and submit services using the most appropriate diagnosis and procedure codes as of the date of service. Reimbursement is allowed only for services submitted with covered codes; claims submitted without covered codes under this Coverage Policy will be denied as not covered.

Use most appropriate codes as of the effective date of submission.
Claims without covered codes will be denied as not covered.

Prior Authorization

Prior Authorization Recommended for Dermal Procedures

Prior authorization is recommended/required for dermal procedures (dermabrasion and dermal chemical peels) when coverage is sought for treatment of actinic keratoses. Documentation must include number and distribution of lesions, prior field therapy history, and clinical justification that lesions are diffuse (e.g., ≥10) making targeted therapy impractical.

Background

Excimer laser (308 nm) is a targeted form of ultraviolet B phototherapy that delivers focused UVB to small, discrete skin areas and is intended to increase precision while limiting total UV exposure. Dermabrasion and chemical peels are resurfacing procedures that remove epidermal and superficial dermal layers to allow re-epithelialization; these techniques range from superficial (epidermal) peels and microdermabrasion to medium and deep chemical peels and dermal dermabrasion. Medium and deep peels or dermabrasion are used as field therapies for multiple or diffuse lesions (for example, when there are ≥ 10 lesions or diffuse actinic damage) and may cause expected temporary scabbing and discoloration during healing.

Definitions

Excimer laser therapy — definition and key points

DefinitionA form of ultraviolet laser (308-nm UVB) delivering targeted phototherapy to small, focused skin areas to increase precision and limit total UV exposure.

Typical useEstablished treatment option for localized, plaque psoriasis and used for vitiligo in selected cases; generally applied to small areas (e.g., 2 x 2 cm).

Treatment parametersTreatments typically 2–3 times per week on nonconsecutive days; sessions last ~15–30 minutes and courses range from 4–36 weeks.

Limitations/contraindicationsNot suitable for large total-body treatment; contraindicated in known photosensitivity, porphyria, or systemic lupus erythematosus.

Dermabrasion / Chemical peel — definition and use for large/diffuse lesions

Definition

Policy Summary

PayerCigna

PolicyExcimer Laser, Dermabrasion and Chemical Peels for Dermatologic Conditions

Policy CodePolicy N/A

Change TypeRevisions and content migrationmaterial updates to phototherapy/excimer and dermabrasion/peel statements

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Dermabrasion for cosmetic indications: Dermabrasion for conditions intended to improve personal appearance or that do not improve functional deficits is considered cosmetic and therefore not medically necessary.

Examples: acne scars, tattoos, fine wrinkles when used solely for appearance.

Document number and distribution of AK lesions (e.g., ≥10) and why targeted therapy is impractical.
Provide prior therapy trials (topical 5-FU, diclofenac, imiquimod, PDT, or other conventional field therapies) and reasons for failure/intolerance/contraindication.
Link covered CPTs (15780, 15781, 15782, 15789, 15793) to diagnosis L57.0 (Actinic keratosis) on submission.

Prior Authorization

Prior Authorization for Phototherapy/Photochemotherapy/Excimer

Prior authorization is recommended/required for phototherapy, photochemotherapy, and excimer laser therapy when seeking coverage. For vitiligo, office-based targeted excimer (308 nm) is considered medically necessary only after documented trials of both a topical corticosteroid AND a topical calcineurin inhibitor for 12 consecutive weeks each, or intolerance/contraindication. Continued therapy requires demonstration of clinical benefit.

Vitiligo: documented 12-week trial of at least ONE topical corticosteroid AND 12-week trial of at least ONE topical calcineurin inhibitor prior to excimer laser.
Continuation coverage requires documented beneficial clinical response.
Prior authorization requests for other indications must include clinical justification and prior treatment history.

Denial Risk

Insufficient Evidence — Potential Denial for Other Indications

There is insufficient evidence to support phototherapy, photochemotherapy, or excimer laser therapy for many other dermatologic conditions; requests for these indications may be denied. Literature is limited to small case series, retrospective reviews, short follow-up, and heterogeneous protocols.

Insufficient evidence indications include, but are not limited to: alopecia areata, atopic dermatitis, psoriatic nail disease, onychomycosis, and other listed conditions in the policy.
Denial is likely when the submitted indication lacks supportive peer-reviewed evidence or when phototherapy/excimer is not an established treatment option.

Denial Risk

Noncovered / Cosmetic Procedures — Denial Risk

Noncovered or cosmetic procedures (superficial dermabrasion/microdermabrasion and epidermal chemical peels) will be denied as not medically necessary when performed solely for aesthetic reasons or indications listed as cosmetic. Ensure diagnosis linkage supports medical necessity.

Not covered: CPT 15783 (dermabrasion; superficial), CPT 15788/15792 (epidermal chemical peels), CPT 17360 (chemical exfoliation for acne) — these may be denied when billed for non-covered diagnoses.
Cosmetic examples: rhinophyma, rosacea, scar revision, photo-aged skin, uneven pigmentation, rhytids, tattoo removal.
Ensure claims for dermabrasion or chemical peels link to Actinic keratosis (L57.0) when coverage is claimed.

Documentation Required

Policy Revisions and Migrated Content — Documentation Impact

Policy revisions and migrated content affect prior authorization and coverage expectations. Content from prior Dermabrasion and Chemical Peels policy was moved and several policy statements were revised or removed; providers should ensure documentation reflects the current policy statements and any removed statements may affect authorization outcomes.

Focused review moved content from CP 0505 into this policy and revised statements for phototherapy/photochemotherapy/excimer and for dermabrasion/chemical peels.
Removed policy statements (e.g., home phototherapy devices, previous session limits) may change prior authorization decisions — verify current policy language before submission.

Step Therapy

Step Therapy Expectation — Document Prior Treatment Trials

Step therapy expectations: For conditions such as alopecia areata or psoriatic nail disease, prior authorization reviewers expect documentation of trials of established therapies (topical/systemic agents, injectable corticosteroids, contact immunotherapy, systemic/biologic therapy where applicable) before considering phototherapy or excimer as an option. Provide dates, duration, and response.

Document trials of established therapies with dates and clinical response.
For vitiligo, specific topical therapy trials (12 weeks each) are required prior to excimer (see Prior Authorization callout).

Documentation Required

Required Prior Topical/Field Therapy Trials for Dermal Field Treatments

Required prior topical/field therapy trials for field treatments: Dermabrasion or medium/deep chemical peels for actinic keratoses require failure, contraindication, or intolerance to one or more conventional field therapies (e.g., topical 5-FU, topical diclofenac, photodynamic therapy, topical imiquimod) before being considered medically necessary.

Field therapy failure must be documented (which agents tried, duration, and reason for discontinuation).
Medium/deep peels or dermabrasion are typically considered only when numerous recalcitrant AKs are present (e.g., ≥10 lesions).

Skin resurfacing procedures that remove the epidermis and superficial skin layers to allow re-epithelialization; used for large or diffuse lesions where lesion-directed therapy is impractical.

Indication exampleEmployed as field therapy for multiple or diffuse actinic keratoses (precursor SCC lesions) when other field therapies have failed or are impractical.

Coverage noteDermal-depth procedures may be medically necessary for AK when criteria are met; superficial procedures (microdermabrasion/epidermal peels) are considered cosmetic and not covered.

Alopecia areata — definition

DefinitionAn autoimmune disorder causing patchy hair loss that can progress to total scalp (alopecia totalis) or body hair loss (alopecia universalis); spontaneous remission occurs in up to ~80% of patients and there is no reliable cure.

Therapies consideredTopical/intralesional corticosteroids and contact immunotherapy have been used; phototherapy and excimer laser have insufficient evidence to support routine use for alopecia areata.

Evidence summaryStudies of UVB, PUVA, and excimer laser are limited (case series, small RCTs, heterogeneous) with mixed outcomes and short follow-up.

Dermabrasion — surgical resurfacing definition (mechanical abrasion, microdermabrasion)

Surgical resurfacing definitionDermabrasion is a surgical procedure that resurfaces skin by removing the top layers using mechanical instruments (e.g., high-speed rotary abrasive wheel).

Included modalitiesAlso referred to as abrasion, salabrasion, microdermabrasion, dermaplaning or sanding the skin; laser abrasion (CO2, tunable dye, ruby) and chemobrasion are alternative modalities.

Clinical useUsed for acne scars, tattoos, fine wrinkles and sometimes for multiple recalcitrant actinic keratoses as a field therapy.

Dermabrasion — alternate definition/notes (includes laser, dermaplaning)

Alternate notesDermabrasion may include mechanical instruments (microdermabrasion, dermaplaning) as well as laser abrasion and chemobrasion modalities.

Cosmetic versus medicalProcedures that resurface only the superficial layer (including those for anti-aging) are considered cosmetic when they do not address a functional deficit.

Setting/availabilityMicrodermabrasion can be noninvasive and performed in office or home settings and is typically considered cosmetic.

Chemical peel — definition and classification (superficial, medium, deep)

DefinitionApplication of chemical solutions to produce controlled removal of epidermal and superficial dermal layers (chemexfoliation).

ClassificationCategorized as superficial (epidermal), medium-depth, or deep peels based on penetration into the dermis and clinical indication.

Clinical uses by depthSuperficial peels treat mild photoaging, acne, melasma (considered cosmetic when no functional deficit); medium and deep peels may treat actinic keratoses, moderate photoaging, pigmentary dyschromias, and acne scarring and are used as field therapy for numerous recalcitrant AKs.

phototherapy/photochemotherapy/excimer laser — definition and modalities (narrowband UVB, UVA1, PUVA, 308-nm)

DefinitionTherapeutic use of ultraviolet light modalities (narrowband UVB, UVA1, PUVA) and targeted 308-nm excimer laser/light for dermatologic conditions.

Modalities listedNarrowband UVB, UVA1, PUVA (psoralen + UVA), and 308-nm excimer laser/light (monochromatic excimer light/lamps).

Clinical scopeUsed to treat psoriasis, vitiligo, alopecia areata, mycosis fungoides, pruritus and other dermatologic conditions though evidence quality varies by indication.

Treatment considerationsDevices differ in approval and intended indications; protocols vary by device, condition, and clinical guideline recommendations.