3.0 POLICY
3.1 Dermatological
services shall be cost-shared for the treatment of a covered condition
unless otherwise limited or excluded by this manual.
3.2 Topical treatmentTreatment for
hypertropic scarring and keloids resulting from burns, surgical procedures
or traumatic events 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.