ModifiedUnitedHealthcarePolicy CS069.S

Light and Laser Therapy (Dermatology)

UnitedHealthcare medical policy governing use of light and laser therapies for dermatologic conditions, defining medically necessary indications, investigational/unproven uses, coding, and prior authorization documentation requirements affecting providers submitting claims under UnitedHealthcare benefits.

Policy Summary

PayerUnitedHealthcare

PolicyLight and Laser Therapy (Dermatology)

Policy CodePolicy CS069.S

Change TypeMaterial revisions (coverage and coding updates)

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionWhen requesting prior authorization for laser therapies, document prior/concurrent standard care, device/wavelength, and rationale for the procedure (e.g., for pilonidal disease show surgery and plan for hair-regrowth control).

SourceLink

POLICY UPDATE CHANGES

Revised list of conditions for which treatment with light and laser therapy is unproven and not medically necessary; added "onychomycosis".

Excimer Laser Therapy: Added CPT code 96999; Laser Hair Removal: Added CPT code 17999; Removed CPT code 17380.

Coverage rationale language for laser hair removal in pilonidal sinus disease was replaced to indicate it is medically necessary when performed for control of hair regrowth after surgery.

Application Nebraska Added language to indicate this Medical Policy does not apply to the state of Nebraska; refer to the state-specific policy version.

Application Idaho and Kansas Added language to indicate this Medical Policy does not apply to the states of Idaho and Kansas; refer to the state-specific policy versions.

Replaced language indicating laser hair removal was proven and medically necessary for pilonidal sinus disease when surgery debrided an accumulation of fluid or pus with language indicating hair removal is proven and medically necessary for pilonidal sinus disease treated with surgery for control of hair regrowth.

Added CPT code 96999 for Excimer Laser Therapy and CPT code 17999 for Laser Hair Removal; removed CPT code 17380.

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.

2CPT codes added

1CPT code removed

3states newly excluded

94.4%primary healing rate (pilonidal review)

89.1%PDL resolution rate (Shen meta-analysis)

517HI-Light trial participants

Coverage criteria and policy stances

Infantile Hemangiomas and Port-Wine Stains — when laser may be appropriate

Covered when ALL of the following are met (per indication).

ALL of the following

Infantile hemangiomas (IH) or port-wine stains (PWS) that are residual or refractory after appropriate first-line pharmacologic therapy (e.g., oral propranolol) or when pharmacologic therapy is contraindicated or not tolerated.
Treatment is intended to address residual cutaneous changes after the proliferative phase or to treat medically refractory lesions where laser is reasonably expected to improve lesion appearance or function (for example, reduction of lesion size causing functional impairment).
Laser modality and protocol appropriate to the lesion type and anatomical location (e.g., pulsed dye laser with epidermal cooling for cutaneous lesions; intralesional Nd:YAG or other appropriate intralesional laser for deeper/refractory lesions).
Decision to use laser therapy has been made in consultation with a hemangioma specialist or appropriate dermatology specialist for infants and young children as indicated by clinical practice guidelines (e.g., AAP).
Documentation of prior therapies and rationale for laser use, including documentation of persistent/residual lesion characteristics and goals of therapy.

Vitiligo therapy evidence summary

Evidence summary and policy-level determinations regarding excimer laser and other light/device therapies for vitiligo.

ALL of the following

Excimer laser (EL) and other targeted light therapies have been studied primarily for repigmentation of vitiligo patches; evidence addresses repigmentation rates rather than effects on the underlying autoimmune disease process.
Systematic reviews and randomized trials show mixed results: EL may achieve comparable or superior repigmentation versus some comparators (e.g., localized 308-nm EL vs targeted 311-nm NB-UVB in small single-center trials), but studies are heterogeneous, often small, single-center, and of short duration.
Network meta-analysis suggests EL combined with adjunctive agents (e.g., antioxidants, calcipotriol) may improve rates of >75% repigmentation compared with EL alone; however, trials are limited in size and quality and follow-up is short.
Home-based handheld narrowband UVB combined with topical corticosteroid demonstrated superiority to topical corticosteroid alone for localized vitiligo in a large pragmatic RCT; NB-UVB alone was not superior to topical corticosteroid alone. This supports combination phototherapy approaches but does not establish EL as disease-modifying.

Applicable procedure and diagnosis codes

Applicable CPT/Category III and unlisted 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
96999	Unlisted special dermatological service or procedure (Excimer Laser Therapy)
0479T	Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or thereof
0480T	Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2
17999	Unlisted procedure, skin, mucous membrane and subcutaneous tissue (Laser Hair Removal)

Applicable ICD-10 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 with abscess cyst
L05.02	Pilonidal sinus with abscess

1–10 of 12

1/2

Laser Hair RemovalCPT

17999

Laser Hair Removal (Unlisted procedure, skin, mucous membrane and subcutaneous tissue)

Removed CPT CodesCPT

17380

Previously listed CPT (removed from policy)

Applicable CPT coding changesCPT

96999	Excimer Laser Therapy (Added)
17999	Laser Hair Removal (Added)
17380	Removed CPT code (previously listed)

Prior authorization, documentation, and billing guidance

Prior Authorization

Prior authorization recommended

Prior authorization (PA) may be required for certain device-based dermatologic therapies. Providers should verify member-specific PA rules before scheduling procedures and submitting claims.

Confirm PA requirements with the member's plan and check federal, state, or contractual requirements that may supersede this policy.
When requesting PA, reference applicable procedure and diagnosis codes on the request and supporting documentation.
UnitedHealthcare may require PA for excimer, ablative fractional CO2, laser hair removal for pilonidal disease, and other device-based dermatologic therapies per plan rules.

Billing Rule

Codes referenced for authorization

A consolidated list of codes commonly referenced for authorization and claims submission is provided for reference only. Inclusion does not guarantee coverage — always verify with the member's plan.

Clinical background and context

Background: Light and laser therapies (for example, pulsed dye laser, Nd:YAG, excimer, fractional ablative CO2/Er:YAG lasers, and photodynamic therapy) are used across multiple dermatologic conditions; indications and evidence vary by device and condition, and many indications remain investigational or lack standardized outcome data.

Key definitions and device terminology

Pulsed dye laser (PDL) — definition

DefinitionPulsed dye laser (PDL): a vascular-specific laser developed to treat cutaneous vascular lesions; often delivered with epidermal cooling (e.g., cryogen spray) to reduce epidermal injury and target superficial capillaries in port‑wine stains and hemangiomas.

Typical useUsed to remove, lighten, reduce in size, or cause regression of cutaneous vascular lesions and to relieve or prevent medical or psychological complications of PWS and residual hemangioma skin changes.

Mechanism noteEmits a single wavelength of light with adjustable intensity and pulse duration to selectively photocoagulate superficial blood vessels while epidermal cooling protects the skin surface.

Fractional ablative laser fenestration — definition and context

DefinitionFractional ablative laser fenestration: a procedure (eg, CO2 or Er:YAG) that creates arrays of microthermal zones (fenestrations) in hypertrophic or traumatic scar tissue to improve pliability, vascularity, height, and function.

Policy changes and effective dates

2025-10-01state_application_updateLatest

Policy updated to indicate it does not apply to Nebraska; refer to state-specific policy version.

2025-06-01state_application_update

Policy updated to indicate it does not apply to Idaho and Kansas; refer to state-specific policy versions.

2025-01-01coding_and_coverage_update

Added CPT code 96999 for excimer laser therapy and CPT code 17999 for laser hair removal, removed CPT code 17380; clarified excimer laser is cosmetic for vitiligo and added onychomycosis to the list of indications considered unproven/not medically necessary.

Policy Summary

PayerUnitedHealthcare

PolicyLight and Laser Therapy (Dermatology)

Policy CodePolicy CS069.S

Change TypeMaterial revisions (coverage and coding updates)

Effective DateJan 1, 2025

Next Review DateN/A

SourceLink

On This Page

Overall strength of evidence is limited by small sample sizes, single-center designs, variable comparators, heterogeneous treatment parameters, and short follow-up. High-quality, multicenter RCTs with standardized outcomes are needed.

Policy-level determinations: Excimer laser is considered cosmetic and not medically necessary for treatment of vitiligo where the goal is solely cosmetic repigmentation without adequate supporting evidence of durable clinical benefit; selective coverage for light/device therapy may be considered when used in combination with guideline-directed topical therapies and when evidence supports clinically meaningful benefit (documented functional or psychosocial impact and prior appropriate therapies tried), subject to payer-specific rules and exclusions.

CPT: 17106, 17107, 17108 (destruction of cutaneous vascular proliferative lesions) — note: do NOT bill warts as vascular lesions.
CPT: 96999 (Excimer laser therapy — unlisted special dermatological service or procedure).
CPT/Unlisted: 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue) — often used for laser hair removal when no specific CPT exists.
Category III: 0479T, 0480T (Fractional ablative laser fenestration of burn/traumatic scars).

Documentation Required

Coding and claims documentation

Coding and claims documentation must accurately reflect the treated condition and procedure. Misclassification can lead to denials.

Viral or plantar warts are not vascular proliferative lesions; do not report wart treatment with CPT 17106–17108.
When submitting claims or PA requests, include the procedure code, diagnosis code(s), device parameters, and a narrative tying clinical findings to the requested therapy.

Prior Authorization

Pilonidal disease — prior authorization & documentation

For pilonidal sinus disease, PA for laser epilation (LE) should include evidence of prior or concurrent standard care and clear clinical rationale.

Required documentation: prior standard care (education on hair removal, use of supplies, adherence), prior surgeries or abscess management, clinical course, and reason LE is being considered.
Include details of laser device, wavelength selection by Fitzpatrick skin type, number of sessions planned, and objective baseline findings.
ASCRS labels LE for PD as a weak recommendation due to limited evidence; this may affect approval decisions.

Denial Risk

Pilonidal laser — insufficient evidence flag

Evidence for laser epilation in pilonidal disease is limited and heterogeneous. Insufficient or low-quality evidence may lead to denial or request for additional information.

RCTs and systematic reviews show promising but variable results; reviewers may require documentation of disease severity, prior therapies, and rationale for LE.
Expect requests for standardized outcome measures, prior treatment adherence, and justification of LE over alternative therapies.

Prior Authorization

Infantile hemangioma — PA considerations

Infantile hemangioma (IH): laser approaches are generally secondary to propranolol and should be reserved for selected cases. Specialist consultation is advised.

PA considerations: document prior trial of first-line therapy (e.g., oral propranolol) or clear contraindication/intolerance to beta-blockers.
Include hemangioma specialist consultation note describing lesion characteristics, prior medical therapy, response, and rationale for laser.
Laser may be considered for residual skin changes after involution or for refractory lesions; provide lesion size, location, age of patient, and prior response data.

Prior Authorization

Burn scar laser — PA for functional impairment

Burn scar ablative fractional CO2 laser (AFL-CO2) may be considered when functional impairment persists despite conservative care. Prior conservative therapy is expected before approval.

Required documentation: scar age, description (size, location), objective evidence of functional limitation (e.g., range-of-motion measurements, ADL impact), prior conservative treatments (silicone, pressure garments, physical therapy), and response to prior care.
Include planned laser type, treatment parameters, number of sessions, and anticipated treatment area (cm2 or % BSA).
PA reviewers may request photographs, validated scar scores (VSS, POSAS), and documentation showing conservative therapy trial and failure or insufficient response.

Documentation Required

PDT, onychomycosis, vitiligo, rosacea — evidence & PA guidance

Clinical evidence for many device-based dermatologic therapies (onychomycosis, rosacea, vitiligo, acne PDT, etc.) is limited or heterogeneous; PA requests should include supporting evidence and prior therapy trials.

PDT for moderate–severe acne: NICE recommends PDT only if other treatments are ineffective, not tolerated, or contraindicated — include documentation of failure or intolerance to standard pharmacologic therapies.
Onychomycosis: studies show variable outcomes, heterogeneous definitions, short follow-up, and diagnostic inconsistencies — include prior systemic or topical antifungal therapy trials and objective diagnostic testing (KOH, culture, or PCR).
Vitiligo: document BSA affected, prior topical therapies, phototherapy history, adherence, duration, and rationale for device-based or combination therapy. Note HI-Light trial support for NB-UVB + topical corticosteroid combination.
Rosacea/Rhinophyma: include prior topical/systemic therapy trials and objective documentation since evidence for light/laser is limited.

Denial Risk

Insufficient evidence may trigger denial

Insufficient or very low-quality evidence for many light- and laser-based indications increases the risk of denial. Provide high-quality supporting clinical evidence with PA requests.

Interventions with heterogeneous protocols, low-quality RCTs, or limited follow-up (most light therapies for acne, many OM trials) may be denied as not medically necessary.
When available, attach peer-reviewed study summaries, validated outcome measures, and comparative evidence showing benefit over standard care.

Note

Check plan‑specific requirements and conflicts

When coding and PA guidance in this policy conflict with federal, state, or contractual plan requirements, those external requirements govern.

Always check plan-specific requirements and state-specific policy versions (policy history notes exclusions for some states).
If in doubt, contact the member's plan for confirmation prior to scheduling or performing services.

Step Therapy

Conservative therapy & step‑therapy considerations

Consider step therapy and conservative management requirements prior to approval of laser or device-based interventions.

Burn scar laser: require trial of conservative scar care (silicone, pressure garments, topical therapies, physical therapy) before AFL-CO2 for functional impairment.
Vitiligo: require prior topical therapy and/or standard phototherapy before approving newer device combinations; document prior treatment duration and adherence.
General rule: try standard pharmacologic and topical therapies first for acne, vitiligo, rosacea, and onychomycosis; document failures or intolerance.

Documentation Required

Provide supporting clinical evidence

Provide supporting clinical evidence with PA requests to help demonstrate medical necessity.

Attach relevant studies, clinical trial summaries (e.g., HI-Light for vitiligo, key RCTs or meta-analyses), validated outcome scores (VSS, POSAS, VASI), and photographs when applicable.
Summarize prior treatments tried, dates, responses, and why device-based therapy is being requested now.

Denial Risk

Denial risk for unproven indications

Treatments considered unproven or not medically necessary by this policy (e.g., onychomycosis laser, excimer for vitiligo as cosmetic) carry denial risk unless plan-specific coverage dictates otherwise.

Updated policy classifies excimer laser therapy as cosmetic and not medically necessary for vitiligo.
Onychomycosis and many light-based acne therapies are designated unproven/insufficient evidence and may be denied.

Typical devices/codesCommonly delivered with ablative fractional CO2 (10,600 nm) or Er:YAG (2,940 nm); procedure described by Category III codes 0479T (first 100 cm2) and 0480T (each additional 100 cm2).

Clinical contextUsed to treat hypertrophic burn scars when functional impairment is present and after trial of conservative scar care; evidence quality is low but meta-analyses report improvements in validated scar scores.

Pulsed dye laser (PDL) — usage note (alternate)

Usage notePDL is most often used with epidermal cooling to treat residual cutaneous changes after pharmacologic management of infantile hemangiomas and for port‑wine stains; Nd:YAG is used intralesionally for medically refractory lesions.

Clinical placementUnder current paradigms, PDL is generally secondary to beta‑blocker therapy for infantile hemangiomas and is targeted to superficial vascular changes after the proliferative phase.

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

DefinitionLaser epilation / laser hair depilation (LE/LHD): procedures using wavelength‑specific lasers (eg, diode 810 nm, Nd:YAG 1,064 nm, alexandrite 755 nm) to reduce hair in the natal cleft to lower pilonidal disease recurrence risk or control regrowth after surgery.

Typical protocolTreatment protocols often specify device/wavelength chosen by Fitzpatrick skin type (eg, diode for I–IV; Nd:YAG for V–VI) and multiple sessions at 4–6 week intervals to achieve progressive hair reduction.

Clinical rationaleUsed as adjunct to standard care or surgery to reduce recurrence; RCT evidence (Minneci et al.) showed lower one‑year recurrence with adjunctive LE versus standard care (23.2% vs 33.2%).

Fractional laser treatment (FLT) — definition

DefinitionFractional laser treatment (FLT): delivery of laser energy in a fractional pattern to create controlled microthermal injury zones that stimulate scar remodeling and improve scar characteristics such as pigmentation, pliability, vascularity, and height.

Common devicesOften delivered using ablative fractional CO2 lasers (10,600 nm) or Er:YAG (2,940 nm) with typical treatment series of 1–4 sessions and median ~2.5 treatments in burn‑scar studies.

Intended benefitsAims to reduce scar thickness, pain, pruritus and improve validated scar scores (VSS, POSAS) and functional outcomes when scars cause impairment.

Ablative fractional CO2 (AFL‑CO2) — definition and typical wavelength

DefinitionAblative fractional CO2 (AFL‑CO2): an ablative fractional laser modality using carbon dioxide wavelength (10,600 nm) to create microthermal zones that ablate and remodel scar tissue.

Typical wavelengthCO2 wavelength is 10,600 nm (frequently studied in burn‑scar literature) with Er:YAG (2,940 nm) cited as an alternative ablative fractional device.

Evidence summarySystematic reviews and meta‑analyses report statistically significant improvements in validated scar scales after AFL‑CO2, though study heterogeneity and variable outcome measures limit certainty.

Photodynamic therapy (PDT) — definition and components

DefinitionPhotodynamic therapy (PDT): a combined treatment using a photosensitizing agent (eg, 5‑aminolevulinic acid [5‑ALA] or methyl aminolevulinate [MAL]) followed by activation with a light source (eg, red light, IPL, PDL or daylight) to produce a cytotoxic photochemical effect.

Common componentsTypical photosensitizers include 5‑ALA and MAL; commonly used light sources are red light, IPL, and lasers such as PDL; protocols vary in incubation time, light dose, and number of sessions.

Clinical rolePDT has evidence of efficacy for inflammatory acne lesions and may be considered when standard pharmacologic therapies are ineffective, not tolerated, or contraindicated (per NICE guidance), but protocols and quality of evidence are heterogeneous.

Photodynamic therapy (PDT) — tag

TagPhotodynamic therapy (PDT)

SynonymPDT — combines photosensitizer (eg, 5‑ALA/MAL) plus activating light source (red light, IPL, PDL)

ContextConsidered for inflammatory acne in selected circumstances with supporting documentation of prior treatment failure; evidence heterogeneous.

Intense pulsed light (IPL) — definition

DefinitionIntense pulsed light (IPL): a non‑coherent, broad‑spectrum light source (bands generally spanning ~400–1,200 nm) used for photothermolysis of cutaneous targets such as vascular lesions, pigmented lesions, and acne-related inflammation.

ApplicationsUsed in acne and rosacea treatments and as an activating light source in some PDT protocols; evidence quality varies and study protocols are heterogeneous.

LimitationsClinical benefit is reported in small trials and reviews for some indications (eg, IPL for acne or vascular lesions), but methodological limitations limit definitive conclusions.

Nd:YAG (1,064 nm) — laser definition

DefinitionNd:YAG laser: neodymium‑doped yttrium aluminum garnet laser commonly used at a 1,064‑nm wavelength for treatment of nails (onychomycosis) and deeper vascular lesions.

Typical use1,064‑nm Nd:YAG devices have been used in most trials of laser therapy for onychomycosis; studies report variable mycological cure rates with substantial heterogeneity.

Skin selection noteNd:YAG (1,064 nm) is often selected for darker Fitzpatrick skin types due to deeper penetration and lower epidermal melanin absorption compared with shorter wavelengths.

Excimer laser (EL) — targeted UV therapy definition

DefinitionExcimer laser (EL): a targeted ultraviolet light therapy device commonly used to induce repigmentation in vitiligo lesions by delivering focused UVB/UV radiation.

Regulatory noteSeveral excimer laser devices have been cleared by the FDA via the 510(k) process for dermatologic ultraviolet lamp indications.

Clinical contextEL is studied for localized vitiligo repigmentation and is often compared with targeted NB‑UVB in small RCTs and systematic reviews.

Excimer laser (308‑nm) — specific wavelength definition

Definition308‑nm excimer laser: a targeted UVB phototherapy device emitting a 308‑nm wavelength used for localized vitiligo treatment and evaluated in RCTs and systematic reviews.

Comparative evidenceRCTs and systematic reviews report mixed results versus NB‑UVB and excimer lamps; some small studies show faster or greater repigmentation with 308‑nm EL but sample sizes and follow‑up are limited.

Clinical useEmployed for focal vitiligo lesions, often in specialized dermatology settings; device‑specific parameters and protocols vary across studies.

Onychomycosis — definition (reserved)

TermOnychomycosis: a persistent fungal infection of the nail plate and bed that leads to thickened, brittle, discolored nails; evidence for light and laser monotherapy is limited and heterogeneous.

Evidence summarySystematic reviews report variable mycological cure rates with laser treatments (eg, Nd:YAG 1,064 nm) but high heterogeneity, short follow‑up, and limited RCT data make routine coverage unsupported without strong supporting documentation.

Clinical implicationLight and laser therapy for onychomycosis is considered unproven/not medically necessary per the policy due to insufficient quantity and quality of evidence.

2025-01-01coverage_clarification

Replaced prior wording for pilonidal sinus disease to state laser hair removal is medically necessary when performed for control of hair regrowth after surgery.