Treatment of Cutaneous and/or Deep Tissue Hemangioma, Port Wine Stain and Other Vascular Lesions - (0313)

Cigna covers laser destruction (CPT 17106–17108) as medically necessary for port‑wine stains of the face/neck, port‑wine stains of the trunk/extremities with recurrent bleeding or painful nodules, infantile hemangiomas of the face/neck, and cutaneous/deep hemangiomas or other vascular malformations that affect a vital structure causing functional impairment or that cause bleeding, eating/swallowing difficulty, pain, repeated infection, or ulceration; laser or other indications outside these criteria are cosmetic and not medically necessary. Inpatient hospitalization for initiation/administration of oral propranolol is medically necessary only for infants with ulcerated or vital‑structure‑affecting lesions who are ≤8 weeks old or 9 weeks–12 months with lack of home monitoring support or relevant comorbidities (cardiovascular/respiratory or glucose issues), and all services must be billed with the listed CPT codes and supported by clinical documentation per the policy (plan benefits may vary).