1.0 CPT PROCEDURE CODE RANGE
17380, 17999, 96567
- 96999
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 U.S. Food and Drug Administration (FDA)
approved.
3.5 Medically necessary
laser hair removal or electrolysis that primarily corrects or improves
a bodily function is covered, whether or not there is also a concomitant
improvement in physical appearance. This policy clarification is
effective May 6, 2021.
4.0 Exclusions
Services performed for cosmetic
purposes such as removal of tattoos, hair removal, removal of telangiectasias,
spider angiomas, or facial rejuvenation.