ModifiedUnitedHealthcarePolicy CS069IN.06

Light and Laser Therapy (for Indiana Only)

Defines medical necessity and investigational determinations for various light and laser therapies for dermatologic conditions for UnitedHealthcare Community Plan members in Indiana.

Policy Summary

PayerUnitedHealthcare

PolicyLight and Laser Therapy (for Indiana Only)

Policy CodePolicy CS069IN.06

Change TypeUpdated clinical examples and coding

Effective DateFebruary 1, 2026

Next Review Date

Key ActionCheck federal, state, or contractual benefit requirements and ensure medical record documentation supports medical necessity before submitting requests.

SourceLink

POLICY UPDATE CHANGES

Updated list of examples of unproven and not medically necessary light and laser therapies; removed 'excimer'.

Removed language indicating excimer laser therapy is considered cosmetic and not medically necessary for treatment of vitiligo.

Added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and that medical records documentation may be required to assess clinical criteria for coverage.

Removed CPT code 96999 from Applicable Codes.

Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect current information; archived previous policy version CS069IN.05.

Port-wine stains, hemangiomaPDL covered conditions

Pilonidal sinus diseaseLaser hair removal

0479T/0480TAFCO2L covered when criteria met

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.

Acne, onychomycosis, rosaceaNot medically necessary

IndianaGeographic scope

Coverage Criteria and Evidence Summary

Pulsed dye laser (PDL) — Covered indications

Covered when treating vascular lesions as follows:

PDL covered conditions: Pulsed dye laser therapy is proven and medically necessary for treating port-wine stains and cutaneous hemangioma/hemangiomata.

Laser hair removal — Covered indication

Covered when used as follows:

LHR for pilonidal disease: Laser hair removal is medically necessary for treatment of pilonidal sinus disease that has been or is being treated with surgery for control of hair regrowth.

Studies report common regimens (e.g., diode 810 nm for Fitzpatrick I-IV or Nd:YAG 1064 nm for Fitzpatrick V-VI delivered every 4–6 weeks for ~5 sessions).

Fractional ablative laser fenestration for hypertrophic burn scars — Covered criteria

Covered when ALL of the following are met:

Functional impairment and prior conservative treatment: (1) The burn scar is causing functional impairment (e.g., limiting range of motion) and treatment is reasonably expected to improve the functional impairment; 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).

Codes 0479T (first 100 cm2) and 0480T (each additional 100 cm2) apply for billing.

Unproven / Not medically necessary

Not medically necessary indications: Light and laser therapy (including intense pulsed light, photodynamic therapy, Nd:YAG, pulsed dye laser and other laser/light modalities) is unproven and not medically necessary for acne vulgaris, onychomycosis, rhinophyma, and rosacea due to insufficient evidence of efficacy.

Infantile Hemangioma / Port-Wine Stain

Contextual coverage considerations from clinical evidence and guideline excerpts (no explicit coverage criteria stated in these chunks).

Infantile hemangioma laser use: Laser (for example, PDL) is most often used for residual cutaneous changes after the proliferative phase or for lesions incompletely responsive to pharmacologic management; propranolol (beta-blocker) is now typically first-line. Some studies report combination or adjunctive laser use, but evidence is heterogeneous and laser is generally secondary to medical therapy.

Guidelines (AAP) recommend considering laser in select IHs and consultation with a hemangioma specialist.

Pilonidal Sinus Disease - Laser Hair Removal/Epilation

Evidence regarding laser hair removal/epilation for pilonidal sinus disease (PSD).

Pilonidal disease - adjunctive laser epilation: Randomized and observational studies and meta-analyses report reduced recurrence with laser epilation compared with conventional hair removal or standard care in several trials; single-center RCTs showed lower one-year recurrence when laser epilation was added to standard care.

Evidence limited by small number of RCTs, single-center designs, heterogeneity, and variable follow-up.

LE technical considerations: Typical devices/wavelengths and regimen: diode 810-nm for Fitzpatrick I–IV and Nd:YAG 1064-nm for Fitzpatrick V–VI; common protocol described is treatments every 4–6 weeks for approximately five sessions; target hair reduction (~75%) associated with lower recurrence in observational data.

Hypertrophic Burn Scars - AFCO2L

Evidence for AFCO2L in hypertrophic burn scars.

AFCO2L outcomes: Cohort and systematic review data report statistically significant reductions in scar thickness (e.g., ~21% reduction in one cohort) and improvements in POSAS, VSS/POSAS subscores, and patient-reported measures at follow-up with an acceptable safety profile (minor adverse events; ~4% infection/delayed healing in one cohort).

Limitations include heterogeneity of prior/concurrent treatments, variable number of treatments, and incomplete long-term data in some series.

Overall evidence characterization

Evidence summaries report consistent statistically significant improvements in validated scar outcomes in many studies, but overall evidence quality is low-to-very-low and heterogeneous.

Evidence summary: Multiple systematic reviews, meta-analyses, cohort studies, and RCTs report that ablative fractional CO2 lasers (and some reports of non-ablative lasers and PDL) can improve VSS/POSAS, pigmentation, pliability, vascularity, and scar height in hypertrophic burn scars; however, heterogeneity, small study sizes, and low or very low certainty ratings limit confidence in effect estimates.

See Hayes, Cochrane, Buhalog, Choi, Peng and other systematic reviews cited.

Factors modifying treatment effect

Clinical factors associated with reported benefit (from subgroup and observational analyses):

Reported benefit factors: Reported modifiers of treatment effect include scar age (earlier treatment <12 months may improve some outcomes in children), laser type (ablative vs non-ablative vs PDL), treatment interval (shorter intervals in some analyses showed greater improvement), and baseline scar characteristics (larger initial scar height may show greater absolute reductions).

Findings are heterogeneous across studies and subgroup analyses should be interpreted cautiously.

Evidence limitations

Limitations and uncertainty

Limitations: Many studies are small, single-center, retrospective, heterogeneous in laser type and protocols, use variable outcome measures, and have short follow-up; Cochrane and Hayes reviews rate the overall certainty of evidence as low or very low, which limits ability to draw definitive conclusions about clinical effectiveness and long-term benefits/harms.

This uncertainty may affect medical necessity determinations and coverage decisions.

Photodynamic therapy (PDT) — consideration criteria

Coverage stance and conditions for PDT and other light therapies as reflected in guidelines and evidence summaries

PDT for moderate to severe acne (per NICE): Consider photodynamic therapy for people aged 18 and over with moderate to severe acne if other treatments are ineffective, not tolerated, or contraindicated.age >=18

NICE issued a limited 'consider' recommendation due to limited evidence; this is not a strong recommendation and requires documentation of prior/failed standard therapies.

Coverage rationale and conditional allowances

Summary coverage stance reflected in the cited guidance and evidence:

Device therapies for acne: Photodynamic therapy may be considered for adults with moderate to severe acne only when other treatments are ineffective, not tolerated, or contraindicated; other light and laser therapies lack sufficient evidence per guideline assessments (AAD, NICE).

Prior/concurrent standard pharmacologic/topical therapy should be documented when requesting PDT.

Onychomycosis device therapy: Evidence for laser/ light therapy in onychomycosis is mixed; some trials suggest benefit when combined with topical antifungals but monotherapy evidence is limited and inconsistent. Device therapy may be considered adjunctively when systemic/topical antifungals are insufficient or contraindicated, with careful documentation.

Rosacea and rhinophyma: Current evidence is insufficient to broadly recommend light or laser therapy for rosacea and rhinophyma; small, heterogeneous studies show some positive results for modalities such as IPL, PDL, KTP and CO2 in selected patients, but routine coverage is not supported without clear documentation of prior therapies and expected benefit.

Specialty society guidance (AARS, NRS) provides conditional/weak recommendations and emphasizes limited-quality evidence.

Evidence summaries (no explicit coverage criteria in this excerpt)

Clinical trial findings and society guidance summarized below — no explicit mandatory criteria stated in this section.

Comparative effectiveness: Multiple small RCTs and comparative studies report comparable effectiveness among several laser modalities (e.g., KTP vs PDL; LPAL vs PDL; LPAN vs PDL) for reducing erythema/telangiectasia with variable secondary outcomes and adverse effect profiles.

Studies are limited by small size, single-center designs, and heterogeneous protocols.

Rhinophyma treatment: Small case series and observational studies (e.g., Er:YAG, CO2) suggest efficacy for mild-to-moderate rhinophyma with rapid recovery, but sample sizes are small and further research is needed.

Predictors of response: Some studies report that DPL efficacy for erythema is not affected by patient variables studied, whereas telangiectasia response may be better for mild versus severe disease.

Evidence quality:

Coding clarification: viral warts or plantar warts are not considered vascular proliferative lesions; accordingly, laser therapy used to treat warts should not be reported with CPT codes 17106, 17107, or 17108. (Codes 17106–17108 describe destruction of cutaneous vascular proliferative lesions by size.)

For billing of fractional ablative laser fenestration of hypertrophic burn scars, use 0479T for the first 100 cm2 (or part thereof) and 0480T for each additional 100 cm2, per the policy's applicable code list.

No explicit exclusions are stated in the cited clinical evidence excerpts regarding device-based therapies beyond the listed conditions judged unproven; the policy notes that treatment roles (for example, laser versus pharmacologic therapy in infantile hemangioma) are guided by contemporary practice and guideline context rather than a blanket exclusion.

The policy history also documents updates to examples of unproven therapies and clarifies that benefit coverage is subject to federal, state, or contractual requirements and that documentation may be required to determine whether clinical criteria are met.

The evidence base for light and laser therapies in acne vulgaris is insufficient to recommend these modalities as standard therapy: studies are generally small, short-term, often uncontrolled, and heterogeneous in wavelength, dosing, and comparators, limiting interpretation of efficacy.

Guideline statements (e.g., AAD) conclude current evidence remains insufficient to develop recommendations on lasers and light-based devices for acne and call for well-designed RCTs with long-term follow-up to clarify the role of these therapies.

Non‑photodynamic visible light and other non‑PDT light therapies for acne and related indications are supported by very low-quality evidence with substantial heterogeneity and risk of bias across trials, leading to an overall conclusion that non‑PDT light therapies lack sufficient high-quality data to justify routine use.

Systematic reviews and guideline updates emphasize the need for standardized outcome measures and comparisons with established pharmacologic treatments before recommending non‑PDT light modalities as standard care.

Aside from the limited, conditional consideration of photodynamic therapy (PDT) in adults with moderate to severe acne when other treatments have failed, the policy excerpts indicate insufficient evidence to support routine use of most light and laser devices for acne, onychomycosis, rosacea, and rhinophyma.

NICE and specialty society guidance frame PDT as a potential option only after conventional therapies are ineffective, not tolerated, or contraindicated; other device-based therapies are not supported for routine primary treatment given current evidence limitations.

The overall evidence for many laser and light applications is limited by small trial sizes, single‑center or retrospective designs, heterogeneous devices and protocols, short follow-up, and low or very low certainty ratings in systematic reviews, which restricts confident conclusions about effectiveness.

Within the provided excerpts there are no broad, explicit procedural exclusions listed beyond noting evidence limitations; the policy revision history does, however, update examples of therapies considered unproven or not medically necessary.

Policy updates clarified examples of unproven and not medically necessary light and laser therapies; specifically, the prior list was revised and 'excimer' was removed from the examples included in the updated policy history.

The main coverage rationale continues to designate certain indications (e.g., acne, onychomycosis, rhinophyma, rosacea) as unproven or not medically necessary based on insufficient evidence of efficacy.

The policy lists the following conditions as considered unproven and not medically necessary for light and laser therapy due to insufficient evidence of efficacy: acne vulgaris, onychomycosis, rhinophyma, and rosacea.

Applicable procedure codes and coding clarifications are provided for reference; inclusion of a code does not imply coverage and benefit determination remains subject to federal, state, or contractual requirements.

Systematic reviews and comparative studies report that the strength of evidence is generally insufficient to demonstrate the superiority of any specific laser modality across many indications; protocols, pulse widths, and cooling strategies vary and heterogeneity prevents clear conclusions about comparative effectiveness.

For infantile hemangioma, PDL is often the most studied laser but variations in protocols and mixed comparators mean no single laser modality has been definitively shown superior in the literature excerpts provided.

Because many studies are small, heterogeneous, and rated as low or very low certainty (e.g., Cochrane reviews for hypertrophic and keloid scars), routine coverage for laser treatments beyond the policy's proven indications is not supported—the available evidence is inconsistent and outcomes are variable across studies.

This uncertainty supports reserving device-based therapies for select circumstances with appropriate documentation or within the limited conditional allowances described (for example, PDT for adults with moderate to severe acne when conventional therapies have failed).

For acne vulgaris, the policy and guideline excerpts converge on the conclusion that non‑PDT light and laser therapies are not supported as standard treatments because trials are heterogeneous, short-term, and frequently lack appropriate comparators or long-term follow-up.

Therefore, routine use of non‑PDT light or laser modalities for acne is not recommended outside of the narrow, conditional context for PDT described in guideline summaries.

Use of laser or light‑based therapy as a standalone primary treatment for acne, onychomycosis, or rosacea is considered not medically necessary when evidence is limited, inconsistent, or of very low quality and when conventional, evidence‑based topical or systemic therapies have not been tried or are tolerable.

For onychomycosis specifically, systematic reviews conclude the quantity and quality of evidence are insufficient to support laser monotherapy; device-based interventions may be considered adjunctive only in specific, justified clinical contexts.

The provided excerpts do not present an exhaustive explicit list labeled 'not medically necessary' beyond the conditions already identified (acne, onychomycosis, rhinophyma, rosacea); the policy history indicates examples of unproven or not medically necessary therapies were updated but full details are in the policy text.

Absent clear, additional explicit exclusions in these excerpts, determinations about medical necessity should follow the stated coverage rationale and the documented evidence limitations.

The policy revision updated examples of unproven and not medically necessary light and laser therapies; the excerpted policy history notes the list was changed but does not include the complete enumerated examples in this excerpt.

Practitioners should consult the full policy text for the current examples and operational clarifications referenced in the revision history.

Applicable Procedure and Diagnosis Codes

Applicable CPT/HCPCS Procedure CodesCPT

17106	Destruction of cutaneous vascular proliferative lesions; less than 10 sq cm
17107	Destruction of cutaneous vascular proliferative lesions; 10.0 to 50.0 sq cm
17108	Destruction of cutaneous vascular proliferative lesions; over 50.0 sq cm
0479T	Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part thereof, or 1% BSA of infants/children
0480T	Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2 or additional 1% BSA
17999	Unlisted procedure, skin, mucous membrane and subcutaneous tissue

Applicable ICD-10 Diagnosis CodesICD-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
L90.5	Scar conditions and fibrosis of skin
L91.0	Hypertrophic scar
L05.01	Pilonidal cyst with abscess
L05.02	Pilonidal sinus with abscess

1–10 of 12

1/2

Removed/Updated CodesCPT

96999

CPT code removed from Applicable Codes

Fractional ablative laser fenestration billing threshold

Billing threshold — initial unitFirst 100 cm2 or part thereof billed with HCPCS code 0479T

Billing threshold — additional unitEach additional 100 cm2 (or additional 1% BSA in infants/children) billed with HCPCS code 0480T

Unit description — pediatric note0479T applies to first 1% of body surface area for infants/children; 0480T applies to each additional 1% BSA

Associated primary procedure groupingCodes 0479T/0480T are specific to fractional ablative laser fenestration of burn and traumatic scars for functional improvement

Provider Requirements, Prior Authorization, and Documentation

Prior Authorization

Prior Authorization — general note

Prior authorization: Prior authorization is not specified in the excerpts provided for most device-based light and laser therapies. However, plan or state-specific prior authorization requirements may apply — check benefit requirements and the most up-to-date prior authorization lists for Indiana and applicable contracts.

Prior authorization not specified in these excerpts — verify member benefit and state/contract requirements.
Refer to UnitedHealthcare Community Plan of Indiana prior authorization and notification list for codes and device management; some codes in the Applicable Codes section are asterisked to indicate they are not managed for IN medical necessity review at policy effective date.

Prior Authorization

Prior Authorization — device-based acne/rosacea/PDT

Prior authorization expectation exists for certain indications and device-based therapies when evidence is limited or when conservative therapy is required prior to device use. Device-based acne and rosacea therapies and photodynamic therapy (PDT) for acne frequently require prior authorization or additional review due to limited or heterogeneous evidence.

Background and Definitions

Multiple sections of the policy identify conditions and therapies for which evidence is insufficient and therefore classified as unproven or not medically necessary—chief examples in the coverage rationale include acne vulgaris, onychomycosis, rhinophyma, and rosacea.

Guideline and evidence summaries repeatedly emphasize heterogeneity, small sample sizes, and need for higher‑quality RCTs before expanding routine coverage for additional laser/light modalities.

Pulsed dye laser (PDL) definition

DefinitionA flashlamp‑pumped pulsed dye laser (PDL) developed for treatment of cutaneous vascular lesions that emits a single wavelength and can vary pulse duration and intensity

Common useUsed to remove, lighten, reduce in size, or cause regression of vascular lesions such as port‑wine stains and hemangiomas

Adjunct featuresCryogen spray cooling (CPDL) may be applied milliseconds before irradiation to protect epidermis while treating deeper vascular targets

Policy Revision History

2026-02-01policy_revision

Updated list of examples of unproven and not medically necessary light and laser therapies; removed 'excimer' from that list.

2026-02-01policy_revision

Removed language stating excimer laser therapy is considered cosmetic and not medically necessary for vitiligo.

2026-02-01documentation_update

Added clarifying language 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.

Policy Summary

PayerUnitedHealthcare

PolicyLight and Laser Therapy (for Indiana Only)

Policy CodePolicy CS069IN.06

Change TypeUpdated clinical examples and coding

Effective DateFebruary 1, 2026

Next Review Date

Key ActionCheck federal, state, or contractual benefit requirements and ensure medical record documentation supports medical necessity before submitting requests.

SourceLink

On This Page

Specialty society guidance acknowledges device use as alternatives or adjuncts but highlights limited-quality evidence and recommends cautious, selective use with documentation and further research.

AARS and NRS statements reflect conditional support with recognition of low-certainty evidence.

Prior authorization expectation for device-based acne therapies (reserved after failure/intolerance of standard topical and/or systemic pharmacologic therapies).

PDT prior authorization for adults with moderate to severe acne when other treatments are ineffective, not tolerated, or contraindicated (consistent with NICE limited recommendation).

Prior authorization recommended for device-based rosacea treatments because evidence is mainly small, single-center, or observational.

Prior Authorization

Prior Authorization — hypertrophic burn scars

Prior authorization is expected for laser treatment of hypertrophic burn scars when used to address functional impairment after conservative measures have failed; documentation must show prior conservative therapy and functional limitation.

Fractional ablative laser fenestration (e.g., CO2, Er:YAG) is considered when the burn scar causes functional impairment and conservative therapy (e.g., hypoallergenic paper tape, pressure garments, silicone kits/gels) has been tried and failed.
Document trial of at least one conventional treatment prior to ablative FLT.
Prior authorization may be required to confirm criteria are met and to review prior conservative care and expected functional improvement.

Note

Check Benefits and Third‑Party Tools

Check benefit requirements and potential use of third‑party review tools (e.g., InterQual) before submitting requests; benefit terms, federal/state/contractual rules, and third‑party criteria may govern coverage decisions.

Verify federal, state, and contractual coverage requirements — these govern in case of conflict with this policy.
UnitedHealthcare may use third‑party tools (e.g., InterQual) to assist in administering benefits; results of such tools and documentation determine authorization outcomes.

Documentation Required

Documentation Requirements — general

Documentation required to support medical necessity: clinical history, exam findings, prior treatments, and defined outcomes are expected. Lack of adequate documentation may result in denial.

Medical records must fully support medical necessity (relevant history, physical exam, diagnostic test results).
Documentation must be legible, maintained in the medical record, and available upon request.
Absence of required documentation may lead to noncoverage or denial.

Denial Risk

Evidence Uncertainty and Impact on Coverage

Evidence uncertainty and study limitations: many device- and light-based therapies are supported by limited, heterogeneous, single-center, or small studies. This uncertainty may affect coverage determinations and lead to requests for additional justification or noncoverage.

Evidence often comes from small RCTs, single-center studies, retrospective cohorts, or observational case series; heterogeneity in methods and outcomes is common.
Limited or low‑quality evidence for many indications (e.g., acne, rosacea, onychomycosis) increases the likelihood that device therapies will require prior authorization and clinical justification.
Coverage decisions are subject to interpretation of the evidence; reviewers may request validated outcome measures or longer-term follow-up data.

Documentation Required

Study Protocol and Required Clinical Outcome Documentation

Study protocol and outcomes documentation commonly used to support requests: provide study-like operational details and outcome measures when seeking authorization for device-based therapies.

Include treatment protocol details: device type and manufacturer, wavelength/setting, number of treatment sessions, spacing/intervals, and treatment area.
Provide clinical outcome documentation using validated scar measures (e.g., POSAS, VSS), acne severity assessments (e.g., IGA), erythema indices, photographic documentation, ultrasound scar thickness, and patient-reported outcomes when applicable.
Report number of sessions, intervals, concurrent therapies (topical/systemic), and follow-up assessments comparable to clinical trials.

Documentation Required

Acne‑Specific Documentation Expectations

Specific documentation elements for acne and device therapies: include acne severity assessment, prior topical/systemic therapies tried and failed or not tolerated, concurrent treatments, and number/timing of prior device sessions.

Document acne severity (e.g., IGA), lesion counts, prior pharmacologic and topical regimens tried (duration and response), and reasons for intolerance or contraindication.
List concurrent or adjunctive therapies being used during device treatment.
Provide the number of prior device treatment sessions, intervals between sessions, device type/settings, and follow-up outcome assessments (e.g., lesion counts at specified timepoints).
NICE recommends considering PDT for adults (≥18) with moderate to severe acne only after other treatments have been tried or are unsuitable; document why standard therapies are ineffective or not tolerated.

Note

Operational Notes and Limitations

Operational and policy caveats: no explicit provider actions are mandated in this section beyond documentation and verification of benefits; coverage remains subject to federal, state, or contractual requirements and may change.

None explicitly stated in this section beyond documentation and benefit verification.
Coverage is subject to federal, state, or contractual requirements and applicable laws; these govern in event of conflict.
Policy updates and effective dates (see Policy History) may change managed codes and prior authorization expectations.

Fractional ablative laser fenestration definition

DefinitionAblative fractional laser fenestration is an ablative laser (e.g., CO2, Er:YAG) technique that creates micro‑fenestrations in hypertrophic burn or traumatic scars to improve thickness, pliability, and function

Typical indicationsTargeted at large symptomatic hypertrophic scars where functional improvement is expected

Treatment characteristicsStudies report a median of ~2–3 treatments, spacing commonly 1–3 months apart; may be combined with topical drug delivery

Pilonidal sinus disease definition

DefinitionPilonidal sinus disease is a chronic infection/cyst in the gluteal cleft often related to hair follicle ingrowth, forming pits or sinuses above the buttock crease

Etiology noteCurrent theory attributes origin to acquired hair penetration into the cleft rather than congenital abnormality

Role of laser hair removalLaser hair removal or depilation is effective as an adjunct or alternative to surgery to control hair regrowth and reduce recurrence

PDL (Pulse dye laser) additional notes

Clinical contextPDL is commonly the first choice of vascular laser therapy for infantile hemangioma and other cutaneous vascular lesions

Pulse width considerationLonger pulse widths are reported to increase transdermal depth and may improve effectiveness for deeper lesions

Combination therapySome evidence suggests combining PDL with oral propranolol may lower adverse events and improve outcomes versus monotherapy in infantile hemangioma

LE / LHD (Laser epilation / Laser hair depilation) definition

DefinitionLE/LHD refers to laser epilation or laser hair depilation techniques (e.g., diode 810 nm, Nd:YAG 1064 nm) used to reduce hair in the natal cleft to prevent pilonidal disease recurrence

Device–skin type pairingDiode 810‑nm devices commonly used for Fitzpatrick I–IV; Nd:YAG 1064‑nm commonly used for Fitzpatrick V–VI

Typical regimenCommon protocol: treatments every 4–6 weeks for approximately five sessions in clinical trials

AFCO2L (Ablative fractional CO2 laser) definition

DefinitionAFCO2L denotes ablative fractional carbon dioxide laser therapy used to remodel hypertrophic burn scars and facilitate topical drug delivery

Typical outcomes reportedStudies report reductions in scar thickness and improvements in validated scar scales (POSAS, VSS) with acceptable safety

Treatment cadenceTreatments are often spaced about three months apart in cohort and trial reports

Ablative fractional CO2 laser (AFL-CO2 / AFCO2L) additional definition

Expanded definitionAFL‑CO2/AFCO2L refers to ablative fractional CO2 laser therapy that creates microscopic columns of ablation to improve scar height, pliability, vascularity, and patient‑reported outcomes in hypertrophic burn scars

Evidence summarySystematic reviews and cohort studies report statistically significant improvements in VSS/POSAS and scar thickness with generally few adverse effects

LimitationsExisting evidence is heterogeneous in protocol, number of treatments, and follow‑up; quality is often low to very low

Photodynamic therapy (PDT) definition

DefinitionPhotodynamic therapy (PDT) combines a topical photosensitizer (e.g., 5‑ALA, MAL) with a light source (red, blue, or daylight) to produce a cytotoxic photochemical effect for conditions such as acne

Common photosensitizers and light sourcesMost common photosensitizers: 5‑ALA and MAL; red light is frequently used as the activating light source

Regulatory noteSeveral PDT devices have received FDA clearance/approvals (see FDA PMA/510(k) listings) and are referenced for informational purposes

Visible light therapy definition

DefinitionVisible light therapy refers to noninvasive modalities (blue, red, or combined blue/red light) used to reduce acne lesion counts, typically without a photosensitizer

Clinical responseSystematic reviews report variable responses; some studies show high partial remission rates but overall evidence quality is limited

Typical treatment coursesReported treatment courses vary widely (from a single session up to >20 sessions) with mean treatment durations reported in reviews of several weeks

Onychomycosis severity indices referenced

Referenced indicesOnychomycosis Severity Index (OSI) and SCIO are cited as clinical measures used in trials to quantify nail infection severity and response

Use in trialsOSI/SCIO and other severity indices are used to document baseline severity and treatment response in onychomycosis laser trials and combination therapy studies

Reporting recommendationDocumentation of severity index scores supports assessment of clinical effect and is commonly recommended in study reports

Pulsed Dye Laser (PDL) — FDA device note

FDA device classificationPulsed dye lasers (PDLs) are Class II devices and multiple PDL models have been FDA‑cleared via 510(k)

Historical noteThe first FDA‑cleared PDL was manufactured in 1986 and PDL remains one of the most frequently used devices for cutaneous vascular lesions

Regulatory referenceRefer to FDA device listings (product code GEX) for current device clearances and substantial equivalence information

Phototherapy / Photodynamic Therapy (PDT) definitions and FDA clearance notes

Definitions and scopePhototherapy encompasses many FDA‑cleared devices (510(k)) delivering various wavelengths (blue, green, yellow, near‑infrared) and photodynamic therapy refers to devices approved via PMA/510(k) that combine photosensitizers with activating light

FDA clearance resourcesFDA device listings and product codes (e.g., FTC, GEX, MVF) provide details on specific cleared or approved phototherapy/PDT devices

Clinical implicationMany phototherapy and PDT devices are marketed with FDA clearance but clinical evidence for specific indications (e.g., acne, onychomycosis) varies and should be considered when evaluating medical necessity

2026-02-01coding_update

Removed CPT code 96999 from the Applicable Codes list.

2026-02-01archiveLatest

Archived previous policy version CS069IN.05 and updated Description of Services, Clinical Evidence, FDA, and References sections.