Light and Laser Therapy (for Tennessee Only) - OpenPayer
ModifiedUnitedHealthcarePolicy CS069TN.R
Light and Laser Therapy (for Tennessee Only)
UnitedHealthcare Tennessee Medicaid/CoverKids policy governing coverage and medical necessity of light and laser therapies (e.g., pulsed dye laser, fractional ablative laser, laser hair removal) for dermatologic indications in Tennessee members.
Policy Summary
PayerUnitedHealthcare
PolicyLight and Laser Therapy (for Tennessee Only)
Key ActionEnsure patient medical record documents history, exam, prior therapies, and diagnostic results to support medical necessity when requesting authorization.
Updated list of examples of unproven and not medically necessary light and laser therapies; removed 'excimer'.
Added requirements that the patient's medical record must contain documentation that fully supports medical necessity and listed examples of such documentation.
Added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and that medical record documentation may be required to assess clinical criteria but does not guarantee coverage.
Updated Supporting Information sections: Description of Services, Clinical Evidence, FDA, and References.
MultipleSystematic reviews/meta-analyses cited
3 RCTsRCTs in PSD meta-analysis
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.
30 RCTs
Infantile hemangioma NMA
several hundredFDA-cleared devices
ManySmall trials/series
Coverage and Medical Necessity Criteria
Medically Necessary Indications
Covered when ALL of the following are met for the indicated conditions:
Pulsed dye laser (PDL): PDL therapy is proven and medically necessary for port‑wine stains and cutaneous hemangioma/hemangiomata.
Supported by Coverage Rationale identifying PDL as proven and medically necessary for these vascular lesions.
Laser hair removal for pilonidal disease: Laser hair removal is proven and medically necessary for pilonidal sinus disease that has been or is being treated with surgery to control hair regrowth.
Supported by Coverage Rationale statement that LHR is proven and medically necessary for PSD in the surgical context.
Fractional ablative laser fenestration for hypertrophic burn scars: Fractional ablative laser fenestration (e.g., CO2, Er:YAG) is proven and medically necessary when BOTH: (1) the burn scar causes functional impairment (limits range of motion) and treatment can reasonably be expected to improve function, AND (2) the individual has tried and failed at least one conventional treatment (e.g., hypoallergenic paper tape, pressure garments, or silicone kits with gel/sheeting).
Matches Coverage Rationale criteria for AFCO2L.
Unproven / Not Medically Necessary Indications
Not medically necessary / Unproven for the following due to insufficient evidence:
Unproven indications: Light and laser therapies (including but not limited to intense pulsed light, photodynamic therapy, Nd:YAG, and pulsed dye laser) are unproven and not medically necessary for acne vulgaris, onychomycosis, rhinophyma, and rosacea due to insufficient evidence of efficacy.
Direct policy statement listing these indications as unproven/not medically necessary.
Infantile Hemangioma / PWS — Coverage conditions
Covered when supported by clinical context and guideline-aligned indications
Infantile hemangioma - laser: Laser (eg, PDL) may be considered when ALL of the following are met: (1) lesion is residual or refractory after appropriate pharmacologic therapy (eg, beta‑blocker/propranolol) or laser is being used as adjunct to beta‑blocker therapy; (2) treatment plan is documented including consultation with or input from a hemangioma specialist when appropriate and rationale for laser use; (3) expected benefit (improvement in residual skin changes or functional/esthetic outcome) outweighs risks based on lesion characteristics and patient age.
Reflects AHRQ and AAP evidence and guidance that PDL is most often used for residual lesions and that propranolol is first‑line; longer‑pulse PDL and combination therapy may reduce adverse events.
Pilonidal Sinus Disease — Coverage conditions
Covered when ALL of the following are met
Pilonidal disease - laser hair depilation: Laser hair depilation/epilation is considered medically reasonable when used as part of a treatment plan to prevent pilonidal disease recurrence with documentation that: (1) standard care measures (eg, hygiene education, mechanical or chemical depilation) have been provided or are planned; (2) there is no active abscess at the time of elective laser treatment; and (3) the proposed laser modality, wavelength appropriate for skin type, number of treatments and treatment intervals are described in the plan.
Supported by RCTs and systematic reviews showing reduced recurrence when LE is added to standard care and by ASCRS guidance recommending hair elimination in absence of abscess.
Hypertrophic Burn Scars — Coverage conditions
Covered when ALL of the following are met
Hypertrophic burn scar - AFCO2L: Ablative fractional CO2 laser (AFCO2L) may be considered for symptomatic hypertrophic burn scars when: (1) conservative measures have failed (eg, pressure therapy, silicone, dressings) or are not appropriate; (2) the scar causes functional impairment (eg, limits range of motion) or intractable symptoms (eg, pruritus) and treatment is reasonably expected to improve function or symptoms; and (3) documentation includes scar characteristics (severity, duration), prior therapies tried, treatment goals, and proposed AFCO2L protocol (number and spacing of sessions) and any planned concurrent therapies (eg, intradermal or topical corticosteroids).
Consistent with cohort studies, meta‑analyses, and HTA conclusions that AFCO2L can improve validated scar scores and function but evidence is heterogeneous and of variable quality.
Evidence synthesis for coverage consideration
Evidence and expert consensus relevant to coverage decisions:
Evidence of benefit for hypertrophic burn scars: Multiple cohort studies, systematic reviews and meta‑analyses report statistically significant improvements in validated scar scales (VSS, POSAS, mVSS), scar thickness, pigmentation, vascularity, pliability and patient‑reported outcomes after fractional CO2 and other laser therapies.
See systematic reviews and meta‑analyses reporting improvements (chunks 40,41,46,47).
Heterogeneity and evidence quality limitations: Systematic reviews and Cochrane review note significant heterogeneity across studies, many single‑arm or retrospective designs, and overall low or very low certainty of evidence limiting certainty about clinical importance and durability of benefit.
See Cochrane and Hayes/other reviews (chunks 44,43,46).
Safety findings: Studies report generally low rates of serious complications; transient adverse effects (erythema, edema, blistering, pain) are common and infection or delayed healing are reported but uncommon.
Cohort and reviews report transient symptoms and low rates of infection/delayed healing (chunks 37,46).
PDT for moderate to severe acne (per NICE summary)
Covered when ALL of the following are met (based on NICE 'consider' recommendation):
Age requirement: Patient is aged 18 years or older>=18 years
NICE specifies photodynamic therapy be considered only in adults aged 18 and over (chunk 73).
Severity and prior therapy: Moderate to severe acne AND other standard pharmacologic treatments (topical and/or oral) are ineffective, not tolerated, or contraindicated
NICE recommends PDT only for moderate‑to‑severe acne when other treatments have failed or are not tolerated (chunks 63,73).
Documentation of prior treatments: Clinical records document prior use and failure or intolerance of standard therapies (eg, topical agents, oral antibiotics, isotretinoin where applicable)
Given limited evidence for PDT, documentation of prior standard therapy supports consideration (chunks 63,69,73).
Coverage-relevant evidence summaries
Coverage stance and implied criteria based on guideline statements and evidence summaries in these chunks
Acne - Photodynamic therapy: Consider PDT for adults with moderate to severe acne only if other treatments are ineffective, not tolerated, or contraindicated per NICE; other light/laser modalities lack sufficient evidence per AAD (2024).age >=18
Reflects NICE 'consider' recommendation and AAD 2024 statement of insufficient evidence for lasers/light (chunks 73,74).
Onychomycosis - device therapy: Laser therapies have mixed evidence; combination laser plus topical antifungal showed improved outcomes versus topical alone in some meta‑analyses, but device‑only monotherapy evidence is limited and heterogeneous. Document prior antifungal therapy and mycological confirmation where possible.
Rosacea / Rhinophyma: Evidence is insufficient to broadly recommend light and laser therapy for rosacea/rhinophyma; some modalities (IPL, PDL, KTP, CO2, Er:YAG) show promise in small studies and consensus documents but require shared decision‑making and counseling on limited evidence and potential transient adverse effects.
Evidence-informed coverage context
Coverage considerations based on society guidance and evidence:
General coverage considerations: Society guidance (eg, AARS, NRS) supports use of lasers/IPL for persistent central facial erythema and telangiectasia but notes limited quality of evidence; device treatments are typically adjunctive to medical therapy and selection should consider phenotype, prior medical therapy, and patient preference.
AARS and NRS guidance indicate device use for erythema/telangiectasia with variable strength and recommend combining with medical therapy when appropriate (chunks 98,99).
Phymatous rosacea (rhinophyma)
Phymatous rosacea (rhinophyma):
Rhinophyma treatment modalities: Ablative lasers (eg, CO2, Er:YAG) and surgical techniques are used for established phymatous changes; small case series and single‑center studies report improvement in appearance and symptoms but evidence is limited and further research is needed.
Small studies (eg, Badawi, Nganzeu) report efficacy but are limited by sample size and design (chunks 93,85).
Viral and plantar warts are not vascular proliferative lesions and therefore laser therapy for warts must not be reported with CPT codes 17106–17108. Use the applicable wart procedure codes instead and follow coding guidance in the policy's Applicable Codes section.
Propranolol and other beta‑blockers have become first‑line therapy for infantile hemangioma; as a result, primary laser therapy as initial treatment is generally not favored. Laser (for example PDL) is typically reserved for residual or refractory lesions after appropriate pharmacologic management or used adjunctively with beta‑blocker therapy, and documentation should show prior or concurrent medical therapy and the rationale for laser use.
There is insufficient evidence to support routine use of light and laser therapy for acne vulgaris. Trials are commonly short term, uncontrolled or single‑center, have small sample sizes, and use heterogeneous devices and protocols; high‑quality RCTs with longer follow‑up and comparisons against standard pharmacologic treatments are needed before these therapies can be considered standard care.
NICE made no recommendation for forms of light therapy other than photodynamic therapy because the committee judged the overall quality of studies to be very low. Consequently, other light‑based modalities lack sufficient evidence and are considered unproven for routine use in acne and related indications.
Clinical guidance does not recommend routine use of lasers or light‑based devices for acne; the NICE guideline limits a role to considering PDT for adults (≥18 years) with moderate to severe acne only when standard treatments are ineffective, not tolerated, or contraindicated, and the AAD (2024) states the evidence is insufficient to make recommendations for other laser/light devices.
The evidence base for rosacea is narrow and heterogeneous; many studies are small or observational. As a result, some nonvascular or severe features of rosacea may not respond to light‑based therapy, and outcomes vary by modality and lesion severity.
The policy's examples list of unproven and not medically necessary light and laser therapies has been updated; notably, the previous language classifying the excimer laser as cosmetic/not medically necessary for vitiligo was removed in the latest revision.
Summary: Light and laser therapies remain unproven or not medically necessary for indications where evidence is insufficient—specifically acne vulgaris, onychomycosis, rhinophyma, and rosacea—unless high‑quality comparative data or guideline recommendations support use for a particular clinical scenario.
Laser hair depilation for pilonidal sinus disease is considered medically relevant when used to prevent recurrence as part of a documented treatment plan (for example, after surgery) and when prior or concurrent evidence‑based adjunctive measures have been attempted; laser hair removal for purely cosmetic purposes remains not medically necessary.
Across multiple scar studies and systematic reviews the evidence is heterogeneous and often of low or very low certainty; therefore it is uncertain whether laser therapies reliably produce clinically important, durable benefits for hypertrophic and keloid scars, and coverage decisions should consider study limitations and individual clinical factors.
Light and laser therapies for acne lack sufficient high‑quality evidence to support their routine use; many trials are small, short‑term, and do not compare devices directly with standard topical or systemic pharmacologic treatments, so device‑based treatments are not considered standard therapy in most contexts.
AAD (2024) concludes that available evidence is insufficient to develop recommendations for laser and light‑based devices for acne and calls for randomized trials with long‑term follow‑up; NICE similarly limits consideration of PDT to adults with moderate‑to‑severe disease only after failure or intolerance of standard therapies.
For erythema and telangiectasia related to rosacea, society guidance supports targeted device use (for example PDL, KTP, IPL) for persistent central facial erythema and telangiectasia, but the evidence base is limited and DPL in particular may be suboptimal for severe telangiectasia; coverage should prioritize documented severity, prior medical therapy, and shared decision‑making.
An updated list of example therapies judged unproven or not medically necessary is provided in the policy; this list was revised on 02/01/2026 to reflect current evidence summaries and to remove prior cosmetic designations for specific devices where appropriate.
Procedural and Diagnosis Codes
Cutaneous Vascular Lesion - CPT/HCPCSCPT
17106
Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); less than 10 sq cm.
17107
Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); 10.0 to 50.0 sq cm.
17108
Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); over 50.0 sq cm.
Hypertrophic Burn Scars - CPT/HCPCSCPT
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 (List separately in addition to code for primary procedure).
17999
Unlisted procedure, skin, mucous membrane and subcutaneous tissue.
Laser Hair Removal - CPT/HCPCSCPT
17999
Unlisted procedure, skin, mucous membrane and subcutaneous tissue.
Cutaneous Vascular Lesion - ICD-10ICD-10
D18.00
Hemangioma unspecified site.
D18.01
Hemangioma of skin and subcutaneous tissue.
I78.0
Hereditary hemorrhagic telangiectasia.
I78.1
Nevus, non-neoplastic.
Q82.5
Congenital non-neoplastic nevus.
Q85.89
Other phakomatoses, not elsewhere classified.
Hypertrophic Burn Scars - ICD-10ICD-10
L90.5
Scar conditions and fibrosis of skin.
L91.0
Hypertrophic scar.
Laser Hair Removal - ICD-10ICD-10
L05.01
Pilonidal cyst with abscess.
L05.02
Pilonidal sinus with abscess.
L05.91
Pilonidal cyst without abscess.
L05.92
Pilonidal sinus without abscess.
Other / Unlisted - CPTCPT
17999
Unlisted procedure, skin, mucous membrane and subcutaneous tissue.
FDA Product Codes Mentionedmixed
GEX
Pulsed dye lasers and other laser/phototherapy devices (see FDA 510(k)).
FTC
Phototherapy devices (FDA 510(k)).
MVF
Photodynamic therapy devices (PMA).
Prior Authorization
Provider Action / Prior Authorization Guidance
Prior Authorization Required / Documentation Expectations: Prior authorization is typically required for laser epilation for treatment of persistent symptomatic pilosebaceous disorder (PSD) and for use of laser therapy or photodynamic therapy (PDT) when billed for onychomycosis or other dermatologic indications. Documentation that supports medical necessity must be provided with the prior authorization request. Inclusion of FDA-cleared devices or society guidance does not alone guarantee coverage.
Prior authorization likely required for laser epilation when treating PSD or medically indicated hair removal; include diagnosis, prior treatments, and clinical rationale.
Laser therapy prior authorization considerations: indication, lesion size/location, prior conservative management, and documented functional impairment or symptoms.
PDT prior authorization recommendation: include prior topical/systemic therapy trials, treatment dates, response, and clinical photographs if available.
Onychomycosis laser therapy: prior authorization is likely required; provide microbiologic confirmation (KOH, culture, or PCR) and documentation of prior systemic or topical antifungal therapy and outcomes.
Society guidance or FDA clearance supports device availability but does not ensure benefit coverage; PA is likely despite these endorsements.
Documentation supporting medical necessity required: relevant history, symptom severity, failed conservative/medical therapies, and expected benefit.
Prior Authorization, Documentation, and Operational Guidance
Prior Authorization
PA must capture indication, prior care, and planned LE regimen for PSD
Prior authorization requests for laser epilation in pilonidal sinus disease should document the indication (prevention of recurrence vs cosmetic), prior or concurrent standard care measures, and the planned laser regimen (device type and number of sessions).
Document whether laser epilation is intended to prevent PD recurrence or for cosmetic reasons.
Provide evidence of prior/concurrent standard care (hygiene education, mechanical/chemical depilation, pit excision/curettage, phenol where applicable).
Specify device (e.g., diode 810-nm or Nd:YAG 1064-nm), treatment interval, and total number of planned sessions.
Prior Authorization
PA should document typical session counts and intervals
Prior authorization for laser therapy should include the planned number of sessions and expected intervals because studies commonly report repeated treatments (typically 1–4 sessions) with adults often spaced about three months and pediatric schedules more frequently (approximately 4–8 weeks).
Provide number of sessions planned (e.g., 1–4) and proposed interval between sessions.
Key Terms and Device Definitions
Pulsed Dye Laser (PDL) and Cryogen Spray Cooled PDL — definition and typical uses
DefinitionPulsed dye laser (PDL) — a flashlamp-pumped vascular laser developed for cutaneous vascular lesions that emits a single wavelength with adjustable pulse duration to target blood vessels.
Cryogen spray-cooled PDL (CPDL)Variation of PDL that applies a millisecond cryogen spurt to the epidermis immediately before laser pulse to cool the skin and reduce thermal epidermal injury while allowing deeper vascular effect.
Typical clinical usesTreatment of port‑wine stains (PWS), infantile hemangiomas (IH), and other cutaneous vascular lesions to lighten, reduce size, or cause regression and to alleviate/avoid medical or psychological complications.
Fractional ablative laser fenestration (e.g., CO2, Er:YAG) for hypertrophic burn scars — definition and context
DefinitionFractional ablative laser fenestration — use of ablative fractional lasers (eg, CO2, Er:YAG) to create microscopic columns of ablation (fenestrations) in hypertrophic burn scars to remodel scar tissue and facilitate topical drug delivery.
Policy Revision History
2026-02-01policy_revisionLatest
Updated list of examples of unproven and not medically necessary light and laser therapies (removed 'excimer'); added and clarified medical records documentation requirements and supporting information; archived previous policy version CS069TN.Q.
Policy Summary
PayerUnitedHealthcare
PolicyLight and Laser Therapy (for Tennessee Only)
Key ActionEnsure patient medical record documents history, exam, prior therapies, and diagnostic results to support medical necessity when requesting authorization.
Factors influencing efficacy: Timing since injury, laser type (ablative vs non‑ablative vs PDL), treatment interval and scar characteristics (eg, height, body region) influence outcomes; earlier treatment (<12 months) and specific laser choices may affect results.
Subgroup analyses and meta‑analyses describe these factors (chunks 41,40).
Role in care pathways: Consensus and several reviews consider ablative fractional lasers an intermediate option between conservative care and surgery for symptomatic scars; standardized protocols and documentation of prior conservative care are recommended when authorizing treatment.
Hayes HTA and systematic reviews support role but emphasize limited evidence and need for standardized protocols (chunks 43,46,47).
NRS and AARS guidance acknowledge device use for erythema/telangiectasia but note limited quality evidence (chunks 98,99,85).
Potential denial trigger: primary use of laser as first-line therapy for infantile hemangioma (IH) without documentation of failure or contraindication to recommended pharmacologic therapy.
Documentation expectations for PSD hair removal: documentation of recurrent pain, infection, sinus formation, or functional impairment; prior conservative care (e.g., hygiene measures, antibiotics, incision/drainage) and reasons for failure/unsuitability.
Evidence insufficiency may trigger denials when clinical data do not demonstrate improvement after standard medical therapy or when published guidelines give limited endorsement.
Guideline-limited endorsement may trigger denials when professional society statements recommend medical therapy first or reserve device use for refractory cases.
Medical record documentation required: clinical notes, treatment timeline, past medications/procedures with dates and responses, diagnostic test results, and photographs when applicable.
Required clinical documentation elements: specific diagnosis, objective findings, prior conservative and pharmacologic treatments tried (with dates and outcomes), contraindications to medical therapy if applicable, and planned laser/PDT parameters (device, settings, treatment area).
Suggested clinical documentation elements: measurement of lesion size, pain or symptom scores, infection history, culture/pathology reports, and photographs pre/post treatment.
Role of laser relative to pharmacologic therapy: lasers and devices are generally considered adjunctive or reserved after appropriate medical therapy; verify that pharmacologic options have been considered or attempted where guideline-recommended.
Step approach for infantile hemangioma (IH): conservative observation or first-line pharmacologic therapy (e.g., oral propranolol) is expected before considering laser; include rationale if laser is used earlier.
Conservative therapy expected prior to laser: topical agents, systemic medications, or procedural alternatives as clinically indicated and supported by guidelines.
Consideration of medical therapy before device treatments: provide documentation of trial, intolerance, contraindication, or failure of medical therapy when claiming medical necessity for device-based treatment.
If combining modalities (e.g., AFL-CO2 with PDL) note the combination and rationale.
Prior Authorization
PA for PDT in acne — document adult moderate‑severe disease and prior therapy failure
Photodynamic therapy (PDT) prior authorization for acne should document that the patient is an adult with moderate to severe acne and that standard topical and/or systemic therapies were ineffective, not tolerated, or contraindicated.
Confirm patient age (>=18 years) when citing NICE 'consider' recommendation.
Include documentation of prior treatments tried and reasons for failure or intolerance.
Prior Authorization
PA likely required for onychomycosis device therapy — show prior antifungal therapy and testing
Prior authorization is likely required for laser/device therapy for onychomycosis and should include documentation of prior topical and/or systemic antifungal therapy and mycological testing where available, because evidence is mixed and many studies assess combined laser plus topical antifungal regimens.
Provide prior antifungal treatments (topical and/or systemic) and duration.
Include mycological confirmation (KOH/culture) if available and details of combined therapies if used.
Prior Authorization
PA for rosacea devices — document prior medical therapy and indication
When requesting PA for lasers/IPL to treat persistent central facial erythema or telangiectasia, include documentation of prior medical therapy attempts and rationale for device use, since society guidance supports device use but notes variable evidence quality.
Document prior or concurrent topical/systemic medical therapies and response.
Specify target phenotype (e.g., persistent central facial erythema, telangiectasia) and device selection rationale.
Prior Authorization
PA and benefit determination governed by plan/federal/state rules; records may be required
Prior authorization and benefit determination depend on the applicable federal, state, or contractual benefit plan; PA submissions may require medical records to verify whether clinical criteria are met.
Check the member's federal/state/contractual benefit terms — these govern coverage in case of conflict.
Be prepared to submit medical records if requested to assess clinical criteria.
Step Therapy
Document propranolol trial or contraindication before primary laser for IH
For infantile hemangioma, document prior pharmacologic therapy (propranolol) or a contraindication/intolerance because propranolol is first-line and laser is generally secondary or used for residual disease.
Include dates and outcomes of propranolol therapy or the clinical rationale for not using it.
If laser is adjunctive to propranolol, document combined treatment plan and specialist consultation.
Step Therapy
Step therapy for IH — require beta‑blocker trial before primary laser
A stepwise approach is expected for infantile hemangiomas: favor a trial of beta‑blocker therapy (e.g., propranolol) prior to laser for primary treatment unless contraindicated; reserve laser for residual/refractory lesions or adjunctive use.
If propranolol was not tried, document medical contraindication or intolerance.
Provide hemangioma specialist consultation notes when laser is considered earlier in management.
Step Therapy
Document trial of conservative therapy before laser (intermediate option)
Prior authorization reviewers expect documentation of prior conservative therapies before approving laser: many studies view laser as intermediate between conservative measures and surgery.
Document prior noninvasive measures attempted (e.g., pressure garments, silicone therapy, hygiene measures) and their duration/response.
State why conservative care is insufficient and the functional or symptomatic goals for laser.
Step Therapy
Step therapy suggestion — PDT after failure/intolerance of standard pharmacologic therapies
Reserve PDT for patients who have tried and not responded to or not tolerated standard topical and/or oral pharmacologic therapies per NICE-based logic; prior authorization should reflect this sequence.
List prior topical and systemic therapies with treatment durations and outcomes.
Explain intolerances or contraindications if pharmacologic therapies were not attempted.
Step Therapy
Require trials of established pharmacologic therapies before device treatments where indicated
Guidelines and systematic reviews emphasize trials of established topical or systemic pharmacologic agents before considering device-based therapies, so PA should document trials of these agents where evidence supports medical therapy first.
For acne, document trials of topical agents, oral antibiotics, or isotretinoin and reasons for failure/intolerance.
For onychomycosis, document prior topical/systemic antifungal courses and mycological testing.
Step Therapy
Document medical therapy attempts before device-based interventions when supported by guidance
Society guidance notes higher-quality evidence for topical medical therapies and that device therapies are often adjunctive; prior authorization may therefore require documentation of medical therapy attempts and rationale for choosing device treatment.
Provide documentation of topical/systemic medical therapy trials and responses.
If proceeding to device therapy, include justification referencing guideline context.
Note
Documentation Required
Medical record must document history, exam, and diagnostic tests
Patient medical records must document relevant history, physical exam findings, and results of pertinent diagnostic tests or procedures to support medical necessity for requested laser/light services.
Records must be legible, maintained in the medical record, and available upon request.
Documentation Required
Document lesion type, prior therapies, residual/refractory status, and consultations
Required clinical documentation for laser requests should include lesion type, prior therapies (for IH include propranolol use), whether lesion is residual or refractory, and consultations with appropriate specialists.
For IH: document propranolol trial, specialist consultation, and rationale for laser (residual/refractory).
For PSD: document absence of active abscess and prior standard care measures.
Documentation Required
For scar cases include validated scar scales and ultrasound thickness plus prior conservative therapy
Clinical documentation for hypertrophic burn scars should include validated scar outcome measures and objective measures such as ultrasound scar thickness, and detail prior conservative therapies.
Include VSS, POSAS, or mVSS scores and baseline ultrasound measurements if available.
Acne documentation: baseline severity and prior therapy trials
For acne device requests include baseline severity (IGA or lesion counts), documentation of prior therapies tried/failed or not tolerated (topical, oral antibiotics, isotretinoin), and objective measures where available.
Provide baseline IGA score or lesion counts and timeline of prior pharmacologic treatments and outcomes.
Note any concomitant treatments used during device therapy.
Documentation Required
Common supporting documentation: clinical scores, mycological testing, session frequency
Supporting clinical documentation commonly used in studies includes clinical scores (OSI, SCIO, VAS, DLQI), mycological testing for onychomycosis, the number and frequency of laser sessions, and follow-up duration.
Include OSI/SCIO scores or DLQI where applicable, and KOH/culture results for onychomycosis.
Provide treatment session dates and frequency and short-term follow-up assessments.
Documentation Required
Document number of sessions, device/wavelength, and short‑term follow‑up
Suggested documentation elements to support PA include the number of prior and planned treatment sessions, device type and wavelength, and short-term follow-up assessments (typically reported at 6 weeks to 6 months).
State device model/wavelength and treatment parameters.
Provide planned follow-up schedule and assessments to evaluate response.
Documentation Required
Records must fully support medical necessity; lack of documentation may cause denial
Medical records submitted for PA must fully support medical necessity, including relevant history, exam, and diagnostic results; failure to provide documentation that supports medical necessity may lead to denial or non‑coverage.
Ensure records are legible and available upon request.
Include all supporting documentation described in policy sections (history, exam, tests).
Billing Rule
Verify federal/state/contractual benefit rules and plan terms for PA
Check federal, state, or contractual requirements when submitting PA requests because these govern benefit coverage and may override the policy; UnitedHealthcare may use third‑party tools to assist in administering benefits.
Verify member-specific plan terms prior to requesting authorization.
Be aware that policy interpretation may be supplemented by tools such as InterQual.
Denial Risk
Provide documentation supporting medical necessity or risk denial
Submit documentation that demonstrates medical necessity for requested laser services — absence of such documentation may lead to denial because benefit coverage is determined by plan terms and supporting records are required to assess criteria.
Provide history, exam findings, diagnostic test results, and prior treatment documentation.
Make records available on request to expedite PA review.
Denial Risk
Denial risk: primary laser for IH without documented propranolol trial or contraindication
Primary laser for infantile hemangioma without documentation of a pharmacologic trial (e.g., propranolol) or a documented contraindication/intolerance may be denied because propranolol is first-line and laser is generally secondary.
If propranolol was not used, include documented contraindications/intolerance or rationale for earlier laser use.
Attach hemangioma specialist consultation when available.
Denial Risk
Denial risk for PSD LE if disease status or prior standard care not documented
For pilonidal disease hair‑removal requests, lack of documentation about disease status (e.g., absence of active abscess), prior standard care measures, and rationale for primary versus adjunctive LE may trigger denial.
Document absence of active abscess when treating with laser epilation.
Provide records showing prior hygiene education, depilation instructions, or other standard care.
Denial Risk
Denial risk when evidence is insufficient (e.g., CO2 for scars)
Insufficient or very low‑certainty evidence for some laser modalities (e.g., fractional CO2 for hypertrophic/keloid scars) reported in systematic reviews may justify denial or requests for additional evidence when clinical benefit is not demonstrated.
Expect scrutiny and potential denial when evidence cited by Cochrane/others is very low certainty.
Provide validated outcome measures and objective data to support benefit.
Denial Risk
Denial risk for PDT in acne if NICE-based prior therapy criteria not documented
Because NICE limits PDT to a 'consider' recommendation for adults with moderate to severe acne only after pharmacologic therapies fail or are not tolerated, absence of documentation meeting those criteria may lead to denial.
Ensure PA includes age, severity, and documentation of prior therapy failure or intolerance for PDT requests.
Denial Risk
Coverage risk for non‑PDT acne light/laser therapies without strong evidence
Use of light and laser therapies beyond PDT for acne lacks strong supporting evidence per NICE and AAD; requests for other laser/light acne treatments may be considered not medically necessary and denied without strong justification.
Provide high‑quality supporting data and prior therapy documentation if requesting non‑PDT device therapies for acne.
Expect coverage risk where guideline support is limited.
Denial Risk
Denial risk for rosacea/device treatments due to limited high‑quality evidence
Evidence for many laser and light‑based treatments for rosacea is limited and often observational; lack of high‑quality evidence may increase the likelihood of denial for indications lacking supportive data.
Include trial data and objective outcome measures to mitigate denial risk for rosacea device requests.
Note concurrent medical therapy and rationale for device selection.
Denial Risk
Denial risk: incomplete or missing documentation supporting medical necessity
Failure to provide medical records that fully support medical necessity — including history, exam, diagnostic results, and prior treatment documentation — may result in denial or non‑coverage.
Ensure all requested records are complete, legible, and available upon request to avoid administrative denials.
Include objective measurements and validated scales where applicable.
Mechanism and devicesAblative fractional CO2 (10,600 nm) and Er:YAG devices produce controlled thermal/ablative injury in a fractional pattern to stimulate remodeling and improve pliability and thickness.
Clinical contextUsed for symptomatic hypertrophic burn scars that impair function (eg, limit range of motion) after failure of conservative measures; commonly delivered in 1–4 sessions spaced weeks to months apart and often paired with topical or intradermal corticosteroid delivery.
PDL — pulse dye laser description and clinical application
DescriptionPDL is a vascular‑targeting laser that emits a specific wavelength optimized for hemoglobin absorption; pulse duration can be varied (longer pulses permit greater depth) and PDL is the most commonly used vascular laser in IH/PWS studies.
Clinical applicationUsed for cutaneous vascular lesions including port‑wine stains and infantile hemangiomas, as monotherapy or combined with beta‑blocker therapy (eg, propranolol) to improve lesion size and reduce adverse events in some regimens.
Evidence noteSystematic reviews and NMAs report PDL as the most commonly applied vascular laser with longer‑pulse PDL often associated with higher efficacy and, when combined with propranolol, lower adverse events in some analyses.
LE / LHD — Laser epilation / laser hair depilation devices and typical wavelengths
DefinitionLaser epilation / laser hair depilation (LE/LHD) — use of hair‑removal lasers to reduce or eliminate hair in affected areas to lower pilonidal disease recurrence risk.
Typical devices & wavelengthsCommon devices used include diode 810‑nm lasers for Fitzpatrick skin types I–IV and Nd:YAG 1064‑nm lasers for Fitzpatrick skin types V–VI, selected to balance efficacy and skin‑type safety.
Clinical use in PSDDelivered as a series (eg, five treatments every 4–6 weeks in one RCT) as adjunct to standard care to reduce one‑year recurrence of pilonidal disease when performed on hair‑bearing natal cleft areas without active abscess.
DefinitionAblative fractional carbon dioxide laser (AFCO2L) — a fractional ablative CO2 device (10,600 nm) used to resurface and remodel hypertrophic burn scars by producing microablative columns and stimulating dermal remodeling.
Typical protocolStudies report a median of ~2.5 treatments (range 1–4) per patient with treatment intervals commonly around 3 months in adults or 4–8 weeks in pediatrics; AFCO2L is often used when scars are symptomatic and after conservative therapy has failed.
AdjunctsAFCO2L may be combined with immediate post‑laser topical or intradermal corticosteroid delivery and medicated dressings to enhance outcomes and reduce hypertrophy recurrence.
Ablative fractional CO2 laser (AFL-CO2 / AFCO2L) — modality and session patterns
ModalityAblative fractional CO2 laser (AFL‑CO2 / AFCO2L) uses 10,600‑nm CO2 energy in a fractional pattern to ablate columns of tissue and promote scar remodeling.
Session patternsMost published series report 1–4 sessions per patient with median ~2–3 sessions; pediatric schedules sometimes use three treatments spaced 4–8 weeks apart with reassessment after the third session.
Indications and outcomesIndicated for large, symptomatic hypertrophic scars targeting improvements in thickness, pliability, pigmentation, and patient/observer scar scores; evidence shows statistically significant improvements but heterogeneity limits certainty of durability.
Pulse dye laser (PDL) — vascular-targeting laser often used alone or with fractional CO2 for scars
MechanismPDL targets hemoglobin in scar vascularity to reduce erythema and vascular components of hypertrophic scars; it can be used alone or in combination with fractional CO2 to address both vascular and textural elements.
Clinical role in scarsOften added for scars with a vascularity subcomponent (eg, mVSS vascularity >0) to improve color and reduce vascular prominence; studies report combined use with AFCO2L in many pediatric and adult series.
EvidenceRetrospective and cohort studies include PDL either alone or paired with fractional CO2; reports indicate improvements in vascularity and some scar domains, though data are heterogeneous.
DefinitionPhotodynamic therapy (PDT) — treatment combining a photosensitizing chemical (eg, aminolevulinic acid [ALA], methyl aminolevulinate [MAL]) with a light source (eg, red, blue, or daylight) to activate the sensitizer and induce a therapeutic photochemical reaction.
ComponentsConsists of a topical/systemic photosensitizer plus an activating light source; photosensitizer concentration and light wavelength/dose vary across protocols and studies.
IndicationsConsidered for adults with moderate‑to‑severe acne when standard therapies are ineffective, not tolerated, or contraindicated (NICE 'consider' recommendation).
Intense Pulsed Light (IPL) — broad-band light therapy used in acne trials
DefinitionIntense Pulsed Light (IPL) — a broad‑band, non‑laser light source using filters to deliver multiple wavelengths used in acne and vascular indications in comparative and single‑arm studies.
Clinical use in acne trialsUsed in multiple trials alone or versus Nd:YAG; treatment regimens and filters vary widely, with sessions commonly given at 3–4 week intervals; evidence quality is heterogeneous and trials are often small.
Comparative findingsSplit‑face RCTs have shown IPL and long‑pulse Nd:YAG produce similar reductions in inflammatory acne lesion counts in some studies, but overall high‑quality comparative evidence is lacking.
Mycological cure / Clinical cure — outcome measures used in onychomycosis studies
DefinitionMycological cure — negative direct microscopy (KOH) and/or negative fungal culture indicating eradication of fungal organism in onychomycosis studies.
Clinical cure / improvementClinical cure or complete cure commonly assessed by nail appearance indices (eg, OSI, SCIO) and percentage improvement in nail plate appearance and patient‑reported outcomes.
Use in trialsOnychomycosis studies report both mycological and clinical cure rates; many laser studies combine device therapy with topical antifungals and report mixed quality evidence and heterogeneity in endpoints.
Photodynamic therapy (PDT) — NICE-recommended context for select adults with acne
NICE recommendationNICE recommends considering photodynamic therapy (PDT) for people aged 18 years and over with moderate to severe acne if other treatments are ineffective, not tolerated, or contraindicated.
Evidence basisRecommendation based on small studies with variable photosensitizers and light sources; overall evidence limited and committee called for further research.
Practice implicationPDT should be reserved for adults with documented prior failure/intolerance of standard topical and/or systemic therapies and requires documentation of prior treatments.
PDL (Pulsed Dye Laser) — Class II FDA-cleared device overview
Regulatory statusPDLs are classified as Class II devices and early PDLs were cleared by FDA via 510(k); multiple models have since been deemed substantially equivalent.
Typical indicationsFDA‑cleared PDL devices are commonly used to treat cutaneous vascular lesions and rosacea‑associated erythema and telangiectasia.
ReferenceFirst PDL was cleared in 1986 (Candela) and subsequent models have been cleared via 510(k).
FDA clearancesHundreds of phototherapy devices have been cleared via 510(k); a number of PDT devices have been approved via PMA; various laser types (PDL, Nd:YAG, Er:YAG, CO2) have FDA listings or clearances.
Product codesFDA product codes referenced in the policy include GEX and FTC (phototherapy/laser PMNs) and MVF (PDT PMAs) for device lookup.
ImplicationDevice‑level indications and parameters vary by manufacturer and cleared claims; clinicians should reference specific device PMN/PMA details for intended use and labeling.