Benignskinlesionremoval
Defines medical necessity criteria for removal or destruction of benign skin lesions (including actinic keratoses and warts), lists procedures and codes, and specifies exclusions (cosmetic/non-medically necessary scenarios). Applies to Health Net of California members; references Medicare NCD/LCD and pharmacy policy where relevant.
Section IV: Removed restriction for PDT with blue light to only face and scalp (Approval Date 3/24).
Added PDT with topical Metvixia (red light) as medically necessary for AKs when criteria met (Approval Date 9/09).
Removed requirement of topical 5-FU or cryosurgery prior to blue-light PDT for non-hyperkeratotic AKs of face and scalp (Approval Date 11/09).
Added references to Medicare NCD 250.4 and LCD L34233 (Approval Date 10/23).
Removed molluscum contagiosum from wart list as it doesn't require excision (09/19).
Removed vascular proliferative disorders from policy because included in Cosmetic and Reconstructive Surgery policy (10/22).
Annual review with references updated (Approval Date 3/26).
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.