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    v1.0.28
    OpenPayerPolicy UpdatesOtorhinolaryngology (ENT)UnitedHealthcare Injectable Filler Coverage | Open…
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    CurrentUnitedHealthcarePolicy CS371.D

    Injectable Dermal Fillers and Bulking Agents

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    This policy governs UnitedHealthcare Community Plan coverage of injectable dermal fillers used for HIV-associated facial lipoatrophy and injectable bulking agents used for vocal fold insufficiency or dysfunction, subject to benefit, contractual, federal, and state requirements.

    Policy Summary
    PayerUnitedHealthcare
    PolicyInjectable Dermal Fillers and Bulking Agents
    Policy CodePolicy CS371.D
    Change TypeInformational updateno material clinical or coverage changes
    Effective DateOctober 1, 2026
    Next Review DateN/A
    Key ActionUse injectable bulking agents for vocal fold insufficiency or dysfunction only in accordance with FDA-labeled indications, contraindications, warnings, and precautions.
    SourceLink
    POLICY UPDATE CHANGES

    The policy history states that the October 1, 2026 revision updated the Description of Services, Clinical Evidence, FDA, and References sections.

    The previous policy version CS371.C was archived.

    The Description of Services, Clinical Evidence, FDA, and References sections were updated to reflect current information.

    2Medically necessary dermal filler products for HIV-associated facial lipoatrophy

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    All other
    Other dermal filler products considered cosmetic
    1Covered bulking-agent indication
    2CPT procedure codes listed
    4HCPCS codes listed

    Medical Necessity and Coverage Criteria

    Dermal Fillers for HIV-Associated Facial Lipoatrophy

    Dermal fillers are covered as reconstructive and medically necessary when ALL of the following are met:

    ALL of the following

    • The individual is living with human immunodeficiency virus (HIV) infection.
    • The treatment is for facial defects due to facial lipoatrophy.

    • ONE of the following dermal filler products is used

      • Radiesse® is used.
      • Sculptra® is used.

    Injectable Bulking Agents for Vocal Fold Insufficiency or Dysfunction

    Injectable bulking agents are covered as proven and medically necessary when ALL of the following 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.

    Cosmetic and Not Medically Necessary Dermal Filler Uses

    The following uses are cosmetic and not medically necessary when ANY of the following apply:

    ANY of the following

    • Radiesse® or Sculptra® is used for an indication other than facial defects due to facial lipoatrophy in an individual living with HIV infection.
    • A dermal filler product other than Radiesse® or Sculptra® is used.

    Radiesse® and Sculptra® are considered reconstructive and medically necessary for the treatment of facial defects due to facial lipoatrophy in individuals living with human immunodeficiency virus (HIV) infection.

    All other dermal filler products are considered cosmetic and not medically necessary.

    Radiesse® and Sculptra® are considered cosmetic and not medically necessary for all other indications.

    The cosmetic and not medically necessary limitation for all other dermal filler products applies regardless of indication.

    Applicable Procedure and Supply Codes

    CPT CodesCPT
    31571Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or
    31574Laryngoscopy, flexible; with injection(s) for augmentation (e.g., percutaneous, transoral), unilateral
    HCPCS CodesHCPCS
    G0429Dermal Filler injection(s) for the treatment of facial lipodystrophy syndrome (LDS) (e.g., as a result of highly active antiretroviral therapy)
    L8607Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies
    Q2026Injection, Radiesse, 0.1ml
    Q2028Injection, Sculptra, 0.5 mg

    Documentation and Coverage Considerations

    Documentation Required

    Medical Records for Clinical Review

    Medical records documentation may be required for clinical review to assess whether the member meets the applicable coverage criteria. Refer to the guidelines titled Medical Records Documentation Used for Reviews.

    • Provide medical records supporting the diagnosis, treatment indication, and clinical criteria applicable to the requested service.
    Denial Risk

    Cosmetic or Noncovered Dermal Filler Indications

    Radiesse and Sculptra are considered cosmetic and not medically necessary for indications other than facial defects due to facial lipoatrophy in individuals living with HIV infection. All other dermal filler products are also considered cosmetic and not medically necessary.

    • Coverage is limited to the covered reconstructive indication: facial defects due to facial lipoatrophy in an individual living with HIV infection.

    Clinical Background

    HIV-associated facial lipoatrophy can occur during treatment with highly active antiretroviral therapy and may have substantial psychosocial and quality-of-life effects. Radiesse and Sculptra are FDA-approved fillers for facial fat loss associated with HIV.

    Key Terms

    Vocal cord insufficiency
    DefinitionA condition in which one or both vocal cords do not open correctly.
    Effect of inadequate glottic closureMay cause vocal fatigue, poor voice quality or tone, and difficulty speaking, swallowing, or coughing.
    Associated risksGreater risk for larynx penetration, aspiration, and pneumonia.
    Vocal fold injection
    DefinitionA treatment that involves injecting a bulking agent into the affected vocal fold.
    Treatment purposeTo assist the affected fold in sufficiently aligning with the opposing fold.
    Treatment options
    Policy Summary
    PayerUnitedHealthcare
    PolicyInjectable Dermal Fillers and Bulking Agents
    Policy CodePolicy CS371.D
    Change TypeInformational updateno material clinical or coverage changes
    Effective DateOctober 1, 2026
    Next Review DateN/A
    Key ActionUse injectable bulking agents for vocal fold insufficiency or dysfunction only in accordance with FDA-labeled indications, contraindications, warnings, and precautions.
    SourceLink
    On This Page
    Medical Necessity and Coverage CriteriaApplicable Procedure and Supply CodesDocumentation and Coverage ConsiderationsClinical BackgroundKey Terms
    Denial Risk

    FDA-Labeled Requirements

    Injectable bulking agents are proven and medically necessary for vocal fold insufficiency or dysfunction only when used according to applicable U.S. Food and Drug Administration (FDA)-labeled requirements.

    • Follow FDA-labeled indications, contraindications, warnings, and precautions.
    Billing Rule

    Benefit and Contractual Limitations

    Meeting the applicable clinical criteria does not guarantee payment. Benefit coverage is determined by federal, state, or contractual requirements and applicable laws that may require coverage for a specific service.

    • Confirm benefit coverage and contractual limitations before providing the requested service.
    Vocal fold injection is one treatment option, along with voice therapy and thyroplasty.
    Vocal fold insufficiency
    Also known asVocal cord dysfunction, paradoxical vocal fold movement, or glottal insufficiency.
    Core conditionOne or both vocal cords do not open correctly.
    Clinical effectsWhen the glottis does not close properly, vocal fatigue, poor voice quality or tone, and difficulty speaking, swallowing, or coughing may occur.