3.0 POLICY
3.1 Dermatological
services may be cost-shared for the treatment of a covered condition
unless otherwise limited or excluded by this manual.
3.2 Topical treatment for hypertropic
scarring and keloids resulting from burns, surgical procedures or traumatic
events may be cost-shared only if there is evidence of impaired
function.
3.3 Medically appropriate treatment
for acne is covered.
3.4 Photodynamic
therapy and photochemotherapy are payable for treatment of conditions
for which the treatment is United States (US) Food and Drug Administration
(FDA) approved.
4.0 Exclusions
Services performed for cosmetic
purposes such as removal of tattoos, hair removal, removal of telangiectasias, spider
angiomas, or facial rejuvenation.