ModifiedUnitedHealthcarePolicy CS069OH.C

Light and Laser Therapy (for Ohio Only)

Policy addressing the medical necessity and investigational status of light and laser therapies for dermatologic conditions for UnitedHealthcare members in Ohio; applies to providers requesting coverage for these services in Ohio.

Policy Summary

PayerUnitedHealthcare

PolicyLight and Laser Therapy (for Ohio Only)

Policy CodePolicy CS069OH.C

Change TypeUpdated examples, removed a CPT code, clarified documentation/coverage language

Effective DateFebruary 1, 2026

Next Review DateN/A

Key ActionProvide complete medical record documentation (history, physical exam, diagnostics, prior therapies) when requesting coverage; documentation may be required for review.

SourceLink

POLICY UPDATE CHANGES

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

Removed CPT code 96999 from Applicable Codes.

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.

1policy versions archived

02/01/2026date of most recent changes

21%AFCO2L mean scar reduction

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Laser epilation 1yr recurrence

0.2%PDL safety — scarring

30 RCTsFei et al. NMA size

Coverage Criteria

inv-01: Medically Necessary Indications

Covered when ALL of the following are met for each indication described below:

Pulsed dye laser for vascular lesions: Pulsed dye laser therapy is proven and medically necessary for treating port‑wine stains and cutaneous hemangioma/hemangiomata.

Laser hair removal for pilonidal sinus disease: Laser hair removal (laser epilation) is proven and medically necessary for treatment of pilonidal sinus disease when used to control hair regrowth in patients who have had or are undergoing surgical management of pilonidal disease.

Fractional ablative laser for hypertrophic burn scars: Fractional ablative laser fenestration (e.g., CO2 or Er:YAG) of hypertrophic burn scars is proven and medically necessary when both criteria below are met:

Fractional ablative laser—criterion 1: The burn scar is causing functional impairment (for example, limiting range of motion) and the proposed treatment can reasonably be expected to improve that functional impairment.

Fractional ablative laser—criterion 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).

inv-02: Not Medically Necessary / Unproven Indications

Unproven / Not Medically Necessary when evidence is insufficient:

Unproven indications: Light and laser therapy, including but not limited to intense pulsed light (IPL), light phototherapy, photodynamic therapy (PDT), Nd:YAG, and pulsed dye laser, is unproven and not medically necessary for the following indications due to insufficient evidence of efficacy:

Unproven — list: Acne vulgaris; Onychomycosis; Rhinophyma; Rosacea.

inv-03: Infantile Hemangioma / Port-Wine Stain — Role of Laser

Guidance from systematic reviews and professional societies on appropriate clinical use

Role of laser for infantile hemangioma: Laser therapy—particularly pulsed dye laser (PDL)—is commonly used for infantile hemangiomas and port‑wine stains; however, with the advent of oral propranolol, laser is often reserved as a secondary or adjunctive option (eg, for residual skin changes after involution or medically refractory lesions). Combination therapy (PDL plus oral propranolol) has been reported to reduce adverse events and may improve outcomes in some analyses.

Fei et al. NMA and AAP guidance support selective/adjunctive laser use rather than routine first‑line use.

inv-04: Pilonidal Sinus Disease — Laser Hair Depilation / Epilation

Evidence from RCTs, systematic reviews, and society guidelines regarding laser hair removal/epilation for pilonidal sinus disease (PSD)

Adjunctive laser epilation reduces recurrence: Randomized trials and meta‑analyses report lower one‑year recurrence rates when laser epilation is used as an adjunct to standard care versus standard hair removal (example: Minneci et al. RCT reported 23.2% vs 33.2% one‑year recurrence), though results are heterogeneous and generalizability is limited by single‑center studies.

Muscat meta‑analysis OR 0.319; Romic et al. systematic review reported high primary healing rates but methodological limitations.

Society guidance for PSD: Professional guidance (ASCRS, SICCR) states hair elimination (including laser) may be used for acute and chronic pilonidal disease in the absence of abscess and may be considered as a primary or adjunct measure; recommendations are cautious/weak because evidence quality is limited.

ASCRS gave a weak recommendation; SICCR notes evidence is low but may be useful after excision.

inv-05: Hypertrophic Burn Scars — AFCO2L

Outcomes and safety for ablative fractional CO2 laser in hypertrophic burn scars

AFCO2L outcomes and safety: Ablative fractional CO2 laser (AFCO2L) treatment of hypertrophic burn scars has been associated with statistically significant improvements in scar thickness (approximately 21% mean reduction at 12 months), POSAS and BBSIP scores, and acceptable safety with low rates of infection or delayed wound healing (reported ~4% of treatments); multiple treatments are commonly required.

Single‑center cohort data (Betar et al.) and pediatric/adult systematic reviews/meta‑analyses support these outcome measures but note heterogeneity and concurrent treatments.

inv-06: Evidence summary for laser treatment of hypertrophic burn scars

Summary of evidence findings (no explicit AND/OR authorization logic present in this segment):

Evidence summary for hypertrophic burn scars: Multiple observational studies, cohort reports, and meta‑analyses report statistically significant improvements in validated scar scales (VSS, POSAS, mVSS) and objective measures (thickness/height) after fractional CO2 and other ablative/non‑ablative laser treatments for hypertrophic burn scars; however, study heterogeneity and generally low to moderate quality limit firm conclusions and indicate a need for additional well‑designed trials.

Effect modifiers include scar age, laser type, and treatment interval.

inv-07: Photodynamic therapy (PDT) — conditional coverage context

Summary of guideline-based coverage stance for acne light/laser therapies

PDT—NICE conditional context: Photodynamic therapy (PDT) may be considered for adults (age ≥ 18) with moderate to severe acne only when other treatments are ineffective, not tolerated, or contraindicated (NICE 'consider' recommendation).age >= 18; moderate‑to‑severe acne; prior standard treatments failed/intolerant/contraindicated

AAD states evidence remains insufficient to develop a recommendation for PDT or other light/laser devices.

inv-08: Other light/laser modalities — not supported as standard therapy

Evidence summary for other light and laser modalities

Other light/laser therapies—evidence limitations: Evidence for other light and laser modalities (eg, blue/red light, Nd:YAG, IPL, diode lasers, fractional CO2, low‑level lasers) is heterogeneous and of low to moderate quality; trials are frequently small, single‑center, short‑term, and lack standardization or appropriate comparators, limiting conclusions about routine effectiveness.variable by study

AAD 2024 and multiple systematic reviews conclude evidence is insufficient to support routine use.

inv-09: Safety considerations including isotretinoin concomitant use

Safety considerations

Isotretinoin and concomitant procedures: Available retrospective data suggest non‑ablative laser therapies have been performed during or shortly after isotretinoin with predominantly mild adverse events; evidence is limited and largely single‑center and retrospective—document informed consent and timing of isotretinoin when relevant.monitor for mild AEs such as erythema, dryness, pain, hyperpigmentation

Clinical judgment and documentation of prior isotretinoin use are recommended.

inv-10: Acne vulgaris — evidence insufficiency

Acne vulgaris

AAD 2024 conclusion on lasers for acne: The American Academy of Dermatology (2024) states that available evidence is insufficient to develop a recommendation on the use of laser and light‑based devices (including PDL, Nd:YAG, diode, KTP, IPL, red/blue light, PDT) for acne vulgaris; RCTs with long‑term follow‑up and comparative effectiveness research are needed.

This supports considering lasers non‑standard without case‑specific justification.

inv-11: Onychomycosis — mixed evidence; adjunctive benefit possible

Onychomycosis (OM)

Overall evidence for OM: The quantity and quality of evidence for laser and light treatments for onychomycosis are insufficient to make definitive recommendations; published studies are heterogeneous with mixed results and unclear long‑term efficacy.

Cochrane and other reviews report limited RCT data and high heterogeneity.

Adjunctive benefit observed in OM: Systematic reviews and meta‑analyses report that laser therapy combined with topical antifungal agents was superior to topical therapy alone for mycological and clinical outcomes in several analyses, suggesting potential adjunctive benefit.

Examples: Zhang et al. 2022; Han et al. 2021; Ma et al. 2019.

Monotherapy uncertainty in OM: Randomized and single‑arm studies show variable mycological cure rates with laser monotherapy; some reviews (eg, Foley et al.) found insufficient evidence to recommend or discourage Nd:YAG 1064 nm or PDT as monotherapy.

Monotherapy results are inconsistent and follow‑up is often short.

inv-12: Rosacea and Rhinophyma — limited supportive evidence, device-specific differences

Rosacea and Rhinophyma

Evidence limitations for rosacea/rhinophyma: Overall quantity and quality of evidence for light and laser therapy in rosacea and rhinophyma are limited by small sample sizes, heterogeneous devices and protocols, uncontrolled designs, and short follow‑up, precluding broad recommendations.

Additional well‑designed studies are needed.

Comparative device findings: Some comparative studies and meta‑analyses report similar efficacy between devices (eg, IPL vs PDL; KTP vs PDL; LPAL vs PDL) with differences in pain, recovery, or secondary symptom response noted, but these findings derive from small trials and require confirmation.

Device‑specific differences in tolerability and recovery have been reported.

Rhinophyma evidence: Small case series and retrospective cohorts indicate CO2 and Er:YAG laser techniques can be effective for rhinophyma with acceptable safety in limited samples, but evidence quality is low.

Surgical interventions remain necessary for severe phymatous disease.

Viral warts and plantar warts are not vascular proliferative lesions and therefore laser therapy for warts should not be reported with CPT codes 17106, 17107, or 17108. Follow coding guidance in the applicable codes section when billing laser procedures for wart treatment to avoid inappropriate CPT reporting.

The document does not list explicit exclusions for infantile hemangioma (IH) laser use, but clinical guidance positions laser therapy as a less-favored first-line option since the introduction of propranolol. PDL is most often reserved for residual skin changes after pharmacologic management, or for medically refractory lesions, and decisions about laser use should be made in consultation with specialists.

A 2022 Cochrane review found very low‑certainty evidence regarding fractional CO2 and other laser treatments for hypertrophic and keloid scars and concluded there is insufficient evidence to support or refute their effectiveness; treatment‑related adverse effects were also judged to have very low‑certainty evidence.

For onychomycosis, the policy states the quantity and quality of evidence are insufficient to recommend laser or light treatments: published studies show mixed results, unclear long‑term efficacy, and no data demonstrating impact on medical complications of infection.

The document explicitly rates the evidence as insufficient across several common dermatologic indications: acne vulgaris, onychomycosis, and rosacea/rhinophyma. Short follow‑up, small samples, heterogeneous protocols, and lack of controlled trials limit support for routine use of light and laser therapies for these conditions.

No single device or treatment is universally curative for rosacea; available guidance notes that severe or chronic phymatous disease may require surgical intervention (including ablative lasers, electrosurgery, or dermabrasion) rather than device‑only therapy.

The policy was updated to revise the list of examples of unproven and not medically necessary light and laser therapies. Notably, language referencing excimer laser for vitiligo was removed from the examples in this revision.

UnitedHealthcare's coverage stance is that light and laser therapies are unproven and not medically necessary for acne vulgaris, onychomycosis, rhinophyma, and rosacea due to insufficient evidence of efficacy; these indications are therefore not supported as routine covered therapies.

Evidence for laser hair depilation (LHD) in pilonidal sinus disease is heterogeneous: randomized trials and meta‑analyses report lower recurrence when LHD is used adjunctively in some studies, but other trials (e.g., Demircan et al.) found no reduction in relapse after surgery. Overall, results are mixed and study designs vary.

For acne vulgaris, available trials are generally short‑term, small, and often lack appropriate controls; systematic reviews (including Cochrane) conclude that high‑quality evidence is lacking and that long‑term randomized studies are needed to determine efficacy of light and laser therapies.

Guideline and evidence summaries indicate that routine use of laser and light‑based devices and photodynamic therapy for acne is not established as standard therapy. Where PDT is considered (per NICE), it is reserved for adults with moderate‑to‑severe acne only after standard treatments are ineffective, not tolerated, or contraindicated.

Because the evidence is insufficient or mixed across multiple indications, the policy states that routine use of laser and light‑based therapies is not recommended for several dermatologic conditions and that these interventions should not be considered standard of care without case‑specific justification.

The evidence base for many device applications is dominated by observational studies and small randomized trials; methodological limitations, heterogeneous outcome measures, and limited sample sizes reduce confidence in pooled estimates and generalizability.

The policy's examples of unproven or not medically necessary light and laser therapies were updated in the February 1, 2026 revision; specifically, references to excimer laser therapy for vitiligo were removed from the list of examples.

Coding

Procedure codes referencedCPT

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.
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.

Diagnosis codes referencedICD-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

Previously listed CPT code removed from Applicable Codes

Fractional ablative laser fenestration billing unit — first 100 cm2 (0479T) and each additional 100 cm2 (0480T)

Billing unit — first unit0479T: Fractional ablative laser fenestration — first 100 cm2 or part thereof (or 1% BSA for infants and children)

Billing unit — additional unit0480T: Fractional ablative laser fenestration — each additional 100 cm2 or each additional 1% BSA or part thereof (list separately in addition to primary procedure)

Typical use caseUsed for fractional ablative laser fenestration of burn and traumatic scars for functional improvement

Provider Actions and Prior Authorization

Billing Rule

Codes referenced for authorization and billing

The following procedure and diagnosis codes are provided for authorization and billing reference only; inclusion does not guarantee coverage or payment. Providers should report applicable CPT/HCPCS codes on prior authorization requests and claims and ensure medical record documentation supports medical necessity. Note: CPT 96999 was removed from the applicable codes list in the 02/01/2026 update; use of unlisted procedure codes (e.g., 17999, 17999 listed for some laser hair/skin procedures) may lead to claim review or denial if documentation is insufficient.

CPT 17106, 17107, 17108 — destruction of cutaneous vascular proliferative lesions (laser)
CPT 0479T, 0480T — fractional ablative laser fenestration of burn/traumatic scars (first 100 cm2; each additional 100 cm2)
CPT 17999 — unlisted procedure, skin, mucous membrane and subcutaneous tissue (used for certain laser hair removal/other procedures)

Note

Background

Background: Light and laser therapies include device classes such as pulsed dye laser (PDL), intense pulsed light (IPL), photodynamic therapy (PDT), Nd:YAG, CO2, and Er:YAG. Uses discussed in the policy include treatment of port‑wine stains, hemangiomas, hypertrophic burn scars, pilonidal sinus disease (laser hair removal), acne, onychomycosis, rosacea, and rhinophyma.

Definitions

Pulsed Dye Laser (PDL) — definition and common wavelength/uses

DefinitionPulsed Dye Laser (PDL): a flashlamp‑pumped laser developed specifically for cutaneous vascular lesions; emits a single wavelength used to target vascular chromophores

Common wavelengthCommonly used wavelength: ~595 nm (devices/variants vary)

Typical usesTreatment of port‑wine stains and cutaneous hemangiomas to remove, lighten, reduce size, or cause regression of vascular lesions

Fractional ablative laser fenestration — procedural technique description

Definition/techniqueFractional ablative laser fenestration: creation of microablative fenestrations (e.g., using CO2 or Er:YAG platforms) in hypertrophic or traumatic scars to remodel tissue and improve pliability and function

Devices/examples

References

References — citations supporting evidence summaries across sections

Scope of referencesComprehensive references include systematic reviews, meta-analyses, randomized trials, and consensus statements across indications (PWS, IH, PSD, burn scars, acne, OM, rosacea)

Selected guideline sourcesIncludes NICE guideline evidence syntheses and AAD 2024 guideline on acne; professional society statements (e.g., ASCRS, SICCR) cited for pilonidal disease

Device and trial literatureReferences cite device-specific trials, cohort studies, and meta-analyses relevant to fractional CO2, PDL, Nd:YAG, IPL, and PDT

Revision History

02/01/2026policy_revisionLatest

Updated list of examples of unproven and not medically necessary light and laser therapies (removed 'excimer') and revised medical records documentation language clarifying that documentation may be required to assess clinical criteria but does not guarantee coverage; CPT code 96999 removed from Applicable Codes.

Policy Summary

PayerUnitedHealthcare

PolicyLight and Laser Therapy (for Ohio Only)

Policy CodePolicy CS069OH.C

Change TypeUpdated examples, removed a CPT code, clarified documentation/coverage language

Effective DateFebruary 1, 2026

Next Review DateN/A

Key ActionProvide complete medical record documentation (history, physical exam, diagnostics, prior therapies) when requesting coverage; documentation may be required for review.

SourceLink

On This Page

Study limitations for OM: Many OM studies are single‑center, small, short‑term, and heterogeneous in patient selection and laser parameters, limiting generalizability and certainty.

Further large, well‑designed RCTs are recommended.

Clinical guideline context (no prior authorization specified)

Clinical practice guidance recognizes laser and light therapies as treatment options in selected scenarios but generally does not mandate payer prior authorization in the source guidance. Guidelines often position lasers after or alongside other modalities (e.g., pharmacologic treatment for infantile hemangioma). Providers should follow specialty guidance and consult relevant specialists when selecting device-based therapies.

AAP: laser may be recommended for select infantile hemangiomas (grade C) and often used for residual changes after pharmacologic therapy
NRS/AARS: lasers/IPL considered options for rosacea phenotypes but evidence is limited; often used adjunctively

Prior Authorization

Prior authorization: clinical justification recommended

Because the quality and consistency of evidence for many light/laser indications are limited, UnitedHealthcare may request clinical justification and supporting documentation when prior authorization is sought. Submit clear documentation showing prior therapies tried, objective severity (e.g., scar scores, lesion size), and the rationale for selecting device-based therapy over or in addition to standard treatments.

Include prior treatment history and response (e.g., failed conservative scar measures, prior pharmacologic therapy for hemangiomas)
Provide objective baseline measures when available (e.g., modified Vancouver Scar Scale, POSAS, OSI, DLQI, IGA)
If surgical or concomitant procedures are planned, document indication and expected functional benefit

Prior Authorization

Prior authorization recommended for PDT and other light/laser therapies

Prior authorization is recommended for photodynamic therapy (PDT) and other light/laser therapies in indications where guidelines recommend reserving these modalities after other standard therapies have failed or are contraindicated (for example, acne PDT per NICE). Requests should document prior adequate trials of first-line therapies and why device-based therapy is indicated.

NICE: PDT for acne (age ≥18) only if other treatments ineffective, not tolerated, or contraindicated
AAD: evidence insufficient to make recommendations for many light/laser devices for acne — document prior pharmacologic therapy trials
Reserve laser/PDT for acne and similar conditions only after documented trials of guideline-recommended therapies

Prior Authorization

Onychomycosis — limited evidence; prior authorization may be required

Onychomycosis device therapies have limited and mixed evidence; combined laser plus topical antifungal approaches show some benefit in RCTs and meta-analyses but evidence quality is low to moderate. Prior authorization may be required and requests should include documentation of prior systemic or topical antifungal therapy and the rationale for adjunctive device use.

Evidence: small RCTs and meta-analyses suggest improved outcomes when laser is combined with topical antifungals versus topical therapy alone, but overall quality and consistency are limited
If seeking coverage for laser in onychomycosis, include prior antifungal treatment history (agents, duration, outcomes) and treatment protocol (number/timing of laser sessions)

Prior Authorization

Prior authorization considerations based on guideline nuance

Guideline nuance influences coverage considerations. Some professional societies provide conditional or weak recommendations (e.g., NICE, ASCRS, AARS, NRS). When guidance limits or conditions device use, UnitedHealthcare may require additional documentation or apply more stringent review.

NICE conditional recommendation for PDT in acne may restrict routine coverage without documentation of failed therapies
ASCRS gives weak recommendation for laser hair removal in pilonidal disease — document surgical history and rationale
AARS/NRS note limited-quality evidence for rosacea device use — document phenotype, prior medical therapies, and expected benefit

Note

Coverage decision framework / use of InterQual

Benefit coverage is determined by federal, state, or contractual requirements and applicable laws. UnitedHealthcare uses InterQual as its primary criteria set for medical/surgical determinations; when InterQual does not have applicable criteria, UnitedHealthcare may rely on its Medical Policies, Coverage Determination Guidelines, and Utilization Review Guidelines as approved by Ohio Medicaid.

InterQual is used for primary medical/surgical criteria
State/federal/contractual requirements govern in case of conflict with this policy

Note

No explicit prior authorization in clinical guidance — check benefit terms

Some source guidance does not specify payer prior authorization requirements for device-based therapies. Absence of guideline-specified PA does not preclude UnitedHealthcare from requesting documentation or requiring authorization based on benefit language, evidence strength, or state/contractual rules.

Clinical guidelines may recommend device options without addressing payer PA; providers should not assume lack of PA requirement
Always confirm plan-specific prior authorization rules and submit supporting documentation as needed

Denial Risk

Insufficient evidence may trigger denial

Insufficient or very low-certainty evidence for many laser/light indications (e.g., acne, onychomycosis, rhinophyma, rosacea features in some contexts) may lead to coverage denial or additional documentation requests. When submitting for review, include high-quality objective measures and prior therapy details to mitigate denial risk.

Cochrane and systematic reviews often rate evidence very low/insufficient for many indications — expect closer scrutiny
Lack of randomized comparative data or small heterogeneous studies increases risk of denial without robust documentation

Denial Risk

NICE conditional recommendation may limit coverage

NICE issued a conditional recommendation for PDT in acne (adults) only when other treatments are ineffective, not tolerated, or contraindicated. Such conditional recommendations may limit routine coverage and prompt prior authorization requiring documentation of prior therapies and their outcomes.

If PDT is requested for acne, provide documentation of failed or intolerant first-line pharmacologic/topical therapies and explanation why PDT is clinically indicated

Denial Risk

Limited high-quality evidence — expect documentation requirements

Across multiple indications the body of high-quality evidence is limited. Systematic reviews and guideline statements frequently call for larger RCTs, standardized protocols, and validated outcome measures. This limited evidence base supports the use of prior authorization and detailed documentation to establish medical necessity.

Providers should include validated outcome measures where available (e.g., VSS, POSAS, OSI, DLQI, IGA)
When evidence is limited, explain rationale, expected clinical benefit, and alternatives tried

Documentation Required

Suggested procedural documentation from trials

Clinical trials and practice reports often specify procedural protocols (number and spacing of sessions) that inform reasonable treatment plans. When requesting authorization, provide the planned protocol and reference the evidence supporting the regimen where available.

Common trial protocols: laser sessions every 4–8 weeks or every 4–6 weeks (e.g., pilonidal epilation studies: five sessions at 4–6 week intervals)
Hypertrophic scar reports commonly scheduled 3 sessions spaced 4–8 weeks apart with reassessment after the third session

Documentation Required

Documentation expectations from evidence limitations

Because many studies are heterogeneous and limited, include objective baseline and follow-up measures to support clinical benefit. Expect requests for severity scores, lesion measurements, and previous treatment documentation to establish necessity.

Baseline severity: mVSS or POSAS for scars; OSI and DLQI for onychomycosis; IGA for acne; lesion size or percent body surface area for vascular lesions
Document prior conservative measures (e.g., pressure garments, silicone kits for scars; propranolol for infantile hemangiomas; topical/systemic antifungals for OM) and outcomes

Documentation Required