Last Review Date

This policy addresses chemical peels (epidermal and dermal/medium-deep), dermabrasion/salabrasion, and treatment of cutaneous hemangiomas, port-wine birthmarks, and other vascular lesions (including laser). Coverage is medically necessary for chemical peels to treat active acne; for medium/deep chemical peels when there are ≥10 actinic keratoses or other premalignant lesions that have failed topical retinoids, topical chemotherapeutic agents, and cryotherapy; and for vascular lesion treatment when there is significant functional impairment (e.g., bleeding or vision interference) with expected improvement; treatment to restore appearance for congenital defect–related significant variation is considered reconstructive. These services are not medically necessary when performed for cosmetic purposes without significant functional impairment (e.g., photoaging, wrinkles, acne scarring, uneven pigmentation), including dermabrasion/salabrasion and vascular lesion treatment that is not reconstructive.