3.0 POLICY
3.1 Dermatological
services may shall 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 shall 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.
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.