Effective for dates of service on or after July 11, 2022, Independence will update the policy position for selective photothermolysis using pulsed-dye lasers (PDL) for certain conditions as experimental/investigational.
- psoriasis (e.g., plaque psoriasis and nail psoriasis)
- molluscum contagiosum
- basal cell carcinoma
- cutaneous lupus erythematosus
- cutaneous sarcoidosis (e.g., lupus pernio)
The position will be experimental/investigational because safety and/or effectiveness of PDL for these indications cannot be established by review of the available published peer-reviewed literature.
The policy update will also identify the following cosmetic conditions:*
- striae distensae (stretch marks)
- cherry angiomas
- spider angiomas
- telangiectasias (facial and leg when not associated with rosacea and meets medically necessary criteria)
- wrinkles
For detailed information, please refer to the following policies, which were posted as Notifications on April 11, 2022, and will go into effect July 11, 2022:
*This is not a comprehensive list. However, they are common indications where usage of selective photothermolysis using PDLs results in cosmetic applications.