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)
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.