Acne TreatmentMedical Policy: 02.01.29 This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply. Acne is a very common disorder of the pilosebaceous follicles that primarily affects adolescents and young adults and may be classified as inflammatory or noninflammatory. Acne is characterized by comedones, nodules and eruptions of papules, pustules, and nodulocystic lesions. Lesions are found in areas where there is the greatest concentration of sebaceous glands, such as the face, neck, and upper part of the trunk. Conventional treatment of active acne usually consists of a good skin care regimen, topical benzoyl peroxide, topical antibiotics or topical retinoids, oral antibiotics, and less often, oral retinoids. Pulse-dye lasers have been investigated for the treatment of active inflammatory acne. Laser therapy at various irradiation levels. (e.g., low and mid-level irradiation lasers and long pulse diode lasers) has been used to destroy active acne lesions enlarged sebaceous glands. Other treatments being investigated for the treatment of active acne involve the use of light in specific wavelengths. Interest in using light as a treatment may be related to the positive short term effects some acne sufferers have experienced from exposure to sunlight. Investigators have worked with intense blue or violet light in the 405-425 nanometer wavelength range and in the red visible spectrum of 660 nanometer range. Photodynamic therapy, also known as photochemotherapy, using 5-aminolevulinic acid followed by exposure to ultraviolet light has also been investigated for the treatment of acne. While Photodynamic therapy has been used successfully for the treatment of actinic keratoses and other lesions it has not been proven safe and effective for the treatment of acne. Treatment of active acne is distinct from the treatment of acne scarring which may occur from tissue damage after inflammatory lesions subside. The treatment of acne scarring is considered cosmetic in nature and therefore is not a contract benefit. Treatment of active acne with the following methods may be considered medically necessary;
Pulse-dye laser or any other type of laser system, intense visible spectrum light, or photodynamic therapy in conjunction with 5-aminolevulinic acid are all considered investigational for the treatment of active acne. Procedure Codes and Billing Guidelines:
*Current Procedural Terminology © 2009 American Medical Association. All Rights Reserved. Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc. They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice. |
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