CurrentUnitedHealthcarePolicy 2026T0650G

Injectable Dermal Fillers and Bulking Agents

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Coverage of injectable dermal fillers and injectable bulking agents for Commercial and Individual Exchange benefit plans, including reconstructive treatment of HIV-associated facial lipoatrophy, vocal fold insufficiency or dysfunction, and non-covered cosmetic uses.

Policy Summary

PayerUnitedHealthcare

PolicyInjectable Dermal Fillers and Bulking Agents

Policy CodePolicy 2026T0650G

Change TypeAdministrative and informational update

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionUse injectable bulking agents only for vocal fold insufficiency or dysfunction and according to FDA-labeled indications, contraindications, warnings, and precautions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Applicable plan types

2Covered dermal filler products for HIV-associated facial lipoatrophy

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CurrentUnitedHealthcarePolicy 2026T0650G

Injectable Dermal Fillers and Bulking Agents

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Policy Summary

PayerUnitedHealthcare

PolicyInjectable Dermal Fillers and Bulking Agents

Policy CodePolicy 2026T0650G

Change TypeAdministrative and informational update

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionUse injectable bulking agents only for vocal fold insufficiency or dysfunction and according to FDA-labeled indications, contraindications, warnings, and precautions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Applicable plan types

2Covered dermal filler products for HIV-associated facial lipoatrophy

2Relative contraindications

Medical Necessity and Coverage Criteria

Dermal Fillers for HIV-Associated Facial Lipoatrophy

Radiesse and Sculptra are considered reconstructive and medically necessary when ALL of the following criteria are met:

ALL of the following

The individual is living with human immunodeficiency virus (HIV) infection.
Treatment is for facial defects due to facial lipoatrophy.
ONE of the following products
- Radiesse is used.
- Sculptra is used.

Injectable Bulking Agents for Vocal Fold Insufficiency

Injectable bulking agents are proven and medically necessary when ALL of the following criteria are met:

ALL of the following

The treatment is for vocal fold insufficiency or dysfunction.
The injectable bulking agent is used according to U.S. Food and Drug Administration (FDA)-labeled indications, contraindications, warnings, and precautions.

Radiesse and Sculptra are considered cosmetic and not medically necessary for all indications other than treatment of facial defects due to facial lipoatrophy in individuals living with HIV infection.

The use of all other dermal filler products is considered cosmetic and not medically necessary.

Dermal filler indications other than treatment of facial defects due to facial lipoatrophy in individuals living with HIV infection are not medically necessary. This limitation includes the use of Radiesse and Sculptra for indications other than HIV-associated facial lipoatrophy.

Products other than Radiesse and Sculptra are considered cosmetic and not medically necessary.

Applicable Procedure and Product Codes

CPT CodesCPT

31570	Laryngoscopy, direct, with injection into vocal cord(s), therapeutic
31571	Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope
31574	Laryngoscopy, flexible; with injection(s) for augmentation (e.g., percutaneous, transoral), unilateral

HCPCS CodesHCPCS

G0429	Dermal Filler injection(s) for the treatment of facial lipodystrophy syndrome (LDS) (e.g., as a result of highly active antiretroviral therapy)
L8607	Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies
Q2026	Injection, Radiesse, 0.1ml
Q2028	Injection, Sculptra, 0.5 mg

Documentation, Coverage Limits, and Denial Risks

Documentation Required

Medical Records May Be Required for Review

Submit medical records and other documentation needed to show that the member meets the applicable clinical criteria for coverage. Documentation may be required for review, but it does not guarantee that the requested service will be covered.

Records may be reviewed to assess whether clinical coverage criteria are met.
Refer to the guidelines titled Medical Records Documentation Used for Reviews.

Denial Risk

Non-HIV Dermal Filler Use Is Not Covered

Radiesse and Sculptra are reconstructive and medically necessary only for facial defects due to facial lipoatrophy in individuals living with HIV. Use for any other indication is considered cosmetic and not medically necessary.

Non-HIV indications are not medically necessary.

Clinical Background

HIV-associated facial lipoatrophy is loss of facial fat associated with HIV infection and, in many cases, highly active antiretroviral therapy. It can substantially affect appearance, quality of life, and treatment adherence. The policy identifies Radiesse and Sculptra as injectable fillers for reconstructive treatment of facial defects resulting from this condition.

Key Clinical Definitions

Vocal Cord Insufficiency / Vocal Fold Dysfunction

ConditionVocal cord insufficiency, also known as vocal cord dysfunction or glottal insufficiency, occurs when one or both vocal cords do not open correctly.

Functional effectsInadequate glottic closure may cause vocal fatigue, poor voice quality or tone, and difficulty speaking, swallowing, or coughing.

Associated risksIndividuals with vocal fold insufficiency have greater risk of larynx penetration, aspiration, and pneumonia.

Vocal Fold Injection

DefinitionVocal fold injection is the injection of a bulking agent into the affected vocal fold.

PurposeThe bulking agent assists the affected vocal fold in sufficiently aligning with the opposing fold.

Policy Summary

PayerUnitedHealthcare

PolicyInjectable Dermal Fillers and Bulking Agents

Policy CodePolicy 2026T0650G

Change TypeAdministrative and informational update

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionUse injectable bulking agents only for vocal fold insufficiency or dysfunction and according to FDA-labeled indications, contraindications, warnings, and precautions.

SourceLink

On This Page

Document the member’s HIV status and facial lipoatrophy when seeking coverage for these products.

Denial Risk

Products Other Than Radiesse or Sculptra

All dermal filler products other than Radiesse or Sculptra are considered cosmetic and not medically necessary under this policy. Claims for these products may be denied regardless of the clinical indication.

Applies to every other dermal filler product.
Do not assume coverage based on the product’s intended use or clinical application.

Billing Rule

Bulking Agents Must Follow FDA Labeling

Injectable bulking agents are covered as medically necessary only for vocal fold insufficiency or dysfunction when used consistently with FDA-labeled indications, contraindications, warnings, and precautions.

Use must be for vocal fold insufficiency or dysfunction.
Confirm that the product and use align with applicable FDA labeling.

Note

Benefit Plan and Documentation Limitations

Coverage is determined by the member-specific benefit plan document and applicable laws. Medical records may be requested to evaluate clinical criteria, but providing documentation does not guarantee coverage of the requested service.

Benefit plan provisions and applicable law control coverage.
Review the member’s benefit plan before rendering or billing the service.

Denial Risk

FDA Status Alone Does Not Establish Coverage

FDA approval or clearance alone is not a basis for coverage. The service must also meet the applicable UnitedHealthcare policy criteria and the member’s benefit plan provisions.

FDA status does not establish medical necessity or payment.
Coverage may differ based on the member-specific benefit plan.

Treatment contextVocal fold injection is one treatment option for vocal cord insufficiency, along with voice therapy and thyroplasty.

HIV-Associated Facial Lipoatrophy

DefinitionHIV-associated facial lipoatrophy is loss of facial fat in individuals living with HIV.

AssociationIt may develop during treatment with highly active antiretroviral therapy.

Identified filler productsRadiesse and Sculptra are identified as FDA-approved injectable treatments for facial fat loss associated with HIV.