CurrentUnitedHealthcarePolicy CS371ID.C

Injectable Dermal Fillers and Bulking Agents (for Idaho Only)

Defines UnitedHealthcare coverage for injectable dermal fillers and vocal fold bulking agents in Idaho, including indications considered medically necessary versus cosmetic, and applicable billing codes.

Policy Summary

PayerUnitedHealthcare

PolicyInjectable Dermal Fillers and Bulking Agents (for Idaho Only)

Policy CodePolicy CS371ID.C

Change TypeCodes added

Effective DateMay 1, 2026

Next Review Date

Key ActionObtain prior authorization when required by the member's plan and submit applicable procedure and supply codes listed in the policy.

SourceLink

POLICY UPDATE CHANGES

Added CPT codes 31570, 31571, and 31574 to Applicable Codes.

IdahoState this policy applies to

2 indicationsIndications covered

31570,31571,31574CPT codes added

Radiesse, SculptraNamed fillers with exceptions

L8607, Q2026, Q2028, G0429HCPCS / Q codes listed

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Coverage Criteria

Medically necessary indications

Covered when meeting the following indication-specific criteria

HIV-associated facial lipoatrophy: Radiesse and Sculptra are reconstructive and medically necessary for treatment of facial defects due to facial lipoatrophy in individuals living with human immunodeficiency virus (HIV).N/A

Radiesse and Sculptra are considered medically necessary only for HIV-related facial lipoatrophy; all other dermal filler products are considered cosmetic and not medically necessary.

Vocal fold insufficiency: Injectable bulking agents are proven and medically necessary for the treatment of vocal fold insufficiency/dysfunction when used according to U.S. Food and Drug Administration (FDA) labeled indications, contraindications, warnings, and precautions.Use per FDA labeling

Includes products cleared for vocal cord medialization (see applicable codes for L8607 and related HCPCS/Q codes).

The use of all other dermal filler products not specifically identified as reconstructive in this policy is considered cosmetic and not medically necessary.

Radiesse and Sculptra are considered cosmetic and not medically necessary for all indications except for treatment of facial defects due to HIV-related facial lipoatrophy, for which they are considered reconstructive and medically necessary.

Coding and Billing

Added/Referenced CPT codes for vocal fold injectionCPT

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 / Q 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.

inv-06: Average length of benefit for CaHA vocal fold injection — approximately 18.6 months (range 8–36 months)

Average length of benefitApproximately 18.6 months (range 8–36 months)

Study population20 patients (22 injections) met inclusion criteria in Carroll and Rosen (2011) cohort

Loss of benefit rate64% (14 of 22 subjects) showed loss of benefit during follow-up

Safety findingsThree complications identified among the original cohort of 108 injections

Provider Actions and Requirements

Prior Authorization

Prior Authorization and Applicable Codes

Prior authorization requirements may apply per the member's plan and benefit terms. Providers should verify eligibility and obtain any required prior authorization before scheduling services.

Check member's plan and benefit contract for prior authorization rules
Listing of a code in this policy does not guarantee coverage or payment

Step Therapy

No explicit step therapy requirements are specified in this policy. If a member's plan includes step therapy protocols, those requirements must be followed and verified prior to authorizing or providing services.

Confirm any plan-specific step therapy rules before treatment
Follow plan step-therapy protocols where applicable

Background

Facial lipoatrophy associated with HIV infection is a well-recognized consequence of antiretroviral therapy that can cause significant psychosocial harm and facial soft-tissue volume loss; FDA-cleared fillers such as Sculptra and Radiesse are recognized reconstructive treatments for these defects in individuals living with HIV. Vocal fold insufficiency is a disorder in which one or both vocal folds fail to close adequately, producing voice impairment, vocal fatigue, and an increased risk of aspiration; injectable bulking agents are an established therapeutic option for medialization to improve voice and swallowing function. Use of bulking agents for vocal fold medialization should follow product labeling and accepted clinical indications.

Definitions

inv-12: Vocal fold insufficiency — definition and common treatments (voice therapy, thyroplasty, injection medialization).

DefinitionVocal fold insufficiency: a condition in which one or both vocal cords do not close properly, causing vocal fatigue, poor voice quality, and increased risk of aspiration.

Conservative treatmentVoice therapy

Surgical optionThyroplasty

Injection therapyInjection medialization (vocal fold injection with bulking agents) to improve glottal closure

inv-13: Facial lipoatrophy (HIV-associated) — definition and relation to HAART; treated with injectable fillers in covered indication.

DefinitionFacial lipoatrophy (HIV‑associated): fat loss of the face seen in patients with HIV on HAART that negatively affects appearance and quality of life.

Revision History

2026-05-01codes_addedLatest

Added CPT codes 31570, 31571, and 31574 to the Applicable Codes list.