L57.0 Insurance Policy Changes

ICD-10 L57.0 is officially defined as "Actinic keratosis." code L57.0 is referenced in 18 tracked payer policy changes from Aetna, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code L57.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 14, 2026High impact
Benign Skin Lesion Removal (CPB 0633, reviewed 2025-09-25)
This is historical material: Aetna's Clinical Policy Bulletin 0633 on benign skin lesion removal, last reviewed 2025-09-25 and first detected by PolicyChanges on 2026-08-14. Aetna covers removal of common benign lesions (such as moles, skin tags, sebaceous cysts, seborrheic keratoses and dermatofibromas) only when a listed medical reason is documented, such as a biopsy showing dysplasia or malignancy, recurrent irritation, symptoms, inflammation, infection or a lesion that blocks vision, and treats removal without those reasons as cosmetic. No effective date is stated, so confirm this is the current version before relying on it.
Excellus BlueCross BlueShield · Effective Oct 22, 2026Medium impact
Light and Laser Therapies for Dermatologic Conditions 8.01.21
Policy 8.01.21 considers UVB light, PUVA, UVA light, FDA-cleared targeted excimer phototherapy, home UVB phototherapy, 5-aminolevulinic acid photodynamic therapy and pulsed dye laser for port wine birthmarks medically appropriate when the listed criteria are met. It considers targeted phototherapy for first-line treatment of mild psoriasis, generalized psoriasis or psoriatic arthritis, and vitiligo investigational, along with photodynamic therapy with topical preparations for other conditions and light or laser treatment of acne. The current effective date is October 22, 2026, and the 10/22/26 annual review left the policy intent unchanged.
Blue Cross & Blue Shield of Mississippi · Effective Feb 5, 2026Medium impact
Dermabrasion
This dermabrasion policy clarifies that benefits are only provided for scar revisions when performed for reconstructive purposes, while dermabrasion for acne scarring, photoaged skin, and wrinkles is considered cosmetic and excluded from coverage. The policy removes outdated ICD-9 codes from the code reference section.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
MA11.103c, Chemical Peels
Independence Blue Cross Medicare Advantage reissued MA11.103c to clarify that chemical peels for actinic keratoses are now covered WITHOUT restrictions based on lesion count or patient characteristics. The policy also removed ICD-10 diagnosis code L57.9 and maintains coverage criteria for dermal peels treating other premalignant lesions (requiring >10 lesions and failed topical therapy), while epidermal peels for non-actinic keratosis premalignant lesions remain non-covered.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
MA11.103c, Chemical Peels
Independence Blue Cross Medicare Advantage has expanded coverage for chemical peels treating actinic keratoses to be medically necessary without restrictions, effective 12/29/2025. Additionally, the ICD-10 code L57.9 has been removed from the policy. Billing teams must update systems to reflect unrestricted coverage for actinic keratosis treatment and ensure proper documentation is submitted with all chemical peel claims.
Aetna · Identified Oct 1, 2026Medium impact
Benign Skin Lesion Removal (CPB 0633, reviewed 2026-09-09)
Aetna's Clinical Policy Bulletin 0633 covers removal of benign skin lesions such as moles, skin tags, sebaceous cysts and seborrheic keratoses when a listed clinical reason applies, such as suspicion of malignancy, recurrent irritation, symptoms, inflammation, or infection. When none of those reasons applies, Aetna treats the removal as cosmetic, and it treats ionized plasma jet therapy and pre-surgical skin ultrasound as experimental. The source is dated by its review on 2026-09-09 and states no effective date for a change, so the billing team should confirm the current bulletin before billing these removals.
Aetna · Identified Oct 1, 2026Medium impact
Pulsed Dye Laser Treatment (CPB 0559, reviewed 2026-09-18)
Aetna's Clinical Policy Bulletin 0559 covers pulsed dye laser treatment. It considers the pulsed dye laser medically necessary for conditions including actinic keratoses that have not adequately responded to imiquimod, 5-FU or cryosurgery, infantile hemangiomas, port wine stains and hemangiomas on the face and neck, and verrucae after at least two conventional therapies have failed. It considers the laser experimental, investigational or unproven for other indications such as active acne, onychomycosis and non-melanoma skin cancer, and cosmetic for conditions such as rosacea, solar lentigines and striae distensae.
Aetna · Identified Sep 29, 2026Medium impact
Actinic Keratoses Treatments (CPB 0567, reviewed 2026-08-21)
Aetna considers cryosurgery with liquid nitrogen, or topical diclofenac, imiquimod, tirbanibulin 1% ointment or 5-fluorouracil with or without tretinoin cream or calcipotriene, medically necessary for destroying actinic keratoses. Curettage or excision is medically necessary for removing actinic keratoses when squamous cell carcinoma is suspected and a specimen is needed for histological analysis, and chemical peel, dermabrasion, laser therapy and photodynamic therapy are medically necessary for members who have not adequately responded to topical imiquimod or 5-FU, or to cryosurgery. Intense pulsed light, microneedling, microwave therapy, thermal photodynamic therapy, non-ablative fractional thulium laser, repetitive daylight photodynamic therapy for prevention, and reflectance confocal microscopy for monitoring treatment are considered experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Carbon Dioxide Laser (CPB 0427, reviewed 2026-07-08)
Aetna's clinical policy bulletin for carbon dioxide laser (CPB 0427) lists the uses it considers medically necessary: condyloma, pelvic pain associated with endometriosis, primary penile tumors (clinical stage Tis, Ta, and T1 Grade 1 to 2), refractory plantar warts, removal of actinic keratoses for members who meet CPB 0567 criteria, removal of superficial basal cell carcinomas, and fractional carbon dioxide laser for hypertrophic burn, traumatic, and surgical scars when conventional therapies have failed. Aetna considers carbon dioxide laser experimental, investigational, or unproven for a list of other indications, including hidradenitis suppurativa, male androgenetic alopecia, onychomycosis, port wine stains, stress urinary incontinence, and vaginal atrophy. Aetna considers carbon dioxide laser treatment of other actinic lesions cosmetic.
Aetna · Identified Aug 14, 2026Medium impact
Dermabrasion, Chemical Peels, and Acne Surgery (CPB 0251, reviewed 2026-04-15)
Aetna considers dermabrasion for superficial basal cell carcinomas and pre-cancerous actinic keratoses, medium and deep chemical peels for actinic keratoses when there are 15 or more lesions, and specified acne surgery procedures medically necessary when criteria are met. Dermabrasion for active acne, diffuse silicone granuloma, dyschromias, keloids, melasma and vitiligo, chemical peels for active acne, and fractional radiofrequency and micro-needling for acne scars and other listed indications are considered experimental, investigational, or unproven. Dermabrasion for scar revision and removal of acne scars, and chemical peels for acne scarring, melasma, and skin wrinkling or lentigines, are considered cosmetic.
Aetna · Identified Aug 14, 2026Medium impact
Pulsed Dye Laser Treatment (CPB 0559, reviewed 2025-08-22)
Pulsed dye laser treatment is medically necessary for actinic keratoses that failed to adequately respond to imiquimod, 5-FU, or cryosurgery, for capillary malformation with overgrowth or vascular malformation, for genital warts when home therapy with podophyllotoxin or imiquimod has failed, for granuloma faciale, for infantile hemangiomas, and for port wine stains and other hemangiomas on the face and neck. It is also medically necessary for keloids or hypertrophic scars from an injury or surgical procedure that cause significant pain requiring chronic analgesic medication or significant functional impairment, for multiple superficially located glomangiomas in the face and neck where surgical excision is not practical, for pyogenic granuloma in the face and neck, for symptomatic angiolymphoid hyperplasia that has failed medical therapy, and for verrucae after at least two conventional therapies have failed. Pulsed dye laser is considered experimental, investigational, or unproven for other conditions, including active acne, onychomycosis, hidradenitis suppurativa, molluscum contagiosum, and morphea, and cosmetic for conditions including rosacea, facial redness, solar lentigines, and striae distensae.
Aetna · Identified Aug 13, 2026Medium impact
Photodynamic Therapy (CPB 0375, reviewed 2026-05-21)
Aetna considers photodynamic therapy with porfimer sodium (Photofrin) medically necessary for esophageal cancer, endobronchial non-small cell lung cancer and inoperable cholangiocarcinoma (as an adjunct to stenting) when the listed criteria are met, and experimental, investigational or unproven when they are not. Photodynamic therapy with topical photosensitizers such as methyl aminolevulinate, topical 5-fluorouracil and aminolevulinic acid is medically necessary for basal cell carcinoma, cutaneous lesions of Bowen's disease, refractory actinic keratoses, low-risk squamous cell carcinoma in situ where surgery or radiation is contraindicated or impractical, and erythroplasia of Queyrat. Photodynamic therapy is considered experimental, investigational or unproven for other cancers and for a long list of non-cancer indications, and the policy applies to commercial medical plans.
Aetna · Identified Aug 12, 2026Medium impact
Cosmetic Surgery and Procedures (CPB 0031, reviewed 2026-06-25)
Aetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary. Surgery needed to improve the functioning of a body part is covered even when it also changes appearance, and the policy lists procedures it considers medically necessary when criteria are met, including blepharoplasty, breast reduction, septoplasty and rhinoplasty, scar revision with symptoms or functional impairment, and removal of symptomatic scrotal and cavernous hemangiomas. It lists procedures it considers cosmetic, including breast augmentation, breast lift, buttock lift, chin and cheek implants, deoxycholic acid (Kybella) injections, electrolysis or laser hair removal, and eyebrow or eyelash tattooing.
Aetna · Identified Aug 12, 2026Medium impact
Optical Coherence Tomography of the Head and Neck (CPB 0928, reviewed 2025-12-30)
Optical coherence tomography (OCT) of the head and neck is considered experimental, investigational or unproven for these uses because their effectiveness has not been established: annual OCT follow-up of thyroid ophthalmopathy after orbital decompression, dynamic OCT for actinic keratosis, endoscopic OCT for tympanoplasty, intra-operative wide-field OCT for deep margins in head and neck surgery, OCT for the middle ear, OCT for diagnosis of oral cancerous lesions, OCT for evaluation of voice disorders, OCT for monitoring radiation-induced skin changes in head and neck cancer, OCT angiography for detecting subclinical low perfusion in giant cell arteritis without manifest ocular involvement and in thyroid-associated ophthalmopathy, and OCT otoscopes for imaging the tympanic membrane and middle ear. CPT 0485T through 0486T, 92133 and 92134 are listed as not covered for the indications in this policy, and so are ICD-10 codes for head and neck cancer, thyroid eye disease, tympanic membrane and middle ear disorders, actinic keratosis, radiation-induced skin changes, giant cell arteritis, voice and resonance disorders, and oral cavity cancer screening.
Aetna · Identified Aug 12, 2026Medium impact
Actinic Keratoses Treatments (CPB 0567, reviewed 2026-04-10)
Aetna considers these treatments medically necessary for actinic keratoses (AK): destruction of AK lesions by cryosurgery with liquid nitrogen, or by topical diclofenac, imiquimod, tirbanibulin 1% ointment, or 5-fluorouracil (5-FU), with or without tretinoin cream or calcipotriene; curettage or excision to remove AK when squamous cell carcinoma is suspected and submission of a specimen for histological analysis is needed; and destruction by chemical peel, dermabrasion, laser therapy, or photodynamic therapy (PDT) for members who have failed to adequately respond to topical imiquimod or 5-FU, or to cryosurgery. The PDT options named are, for example, Ameluz (aminolevulinic acid hydrochloride gel 10% with blue or red light PDT) and Levulan Kerastick (aminolevulinic acid hydrochloride solution 20% with blue light). Aetna considers the following experimental, investigational or unproven for AK because their safety and effectiveness for this indication have not been established (not an all-inclusive list): a cream containing sunscreen, piroxicam and a retinoic/glycolic gel; epidermal radionuclide therapy with 188 Re (Rhenium) resin; intense pulsed light; lapatinib; microneedling; microwave therapy; non-ablative fractional thulium laser; thermal PDT; topical piroxicam; and topical vitamin D and analogs other than calcipotriol. Repetitive daylight PDT for prevention of AK and reflectance confocal microscopy for monitoring AK treatment are also considered experimental, investigational or unproven. CPT codes for shaving, excision, dermabrasion, chemical peel, destruction and PDT are covered if the selection criteria are met. Tirbanibulin 1% ointment, fluorouracil cream and calcipotriene cream have no specific code and are covered if the selection criteria are met. HCPCS codes J7308, J7345 and S0117 and ICD-10 code L57.0 are also listed as covered if the selection criteria are met.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Chemical Peels
Epidermal chemical peels used to treat photo-aged skin, wrinkles, or acne scarring are considered cosmetic, and dermal chemical peels used as a treatment of end-stage acne scarring are considered cosmetic. Dermal chemical peels used to treat individuals with more than 10 actinic keratoses or other premalignant skin lesions, where treating each lesion becomes impractical, may be considered medically necessary. Epidermal chemical peels used to treat individuals with active acne that has failed a trial of topical and/or oral antibiotic therapy are considered medically necessary, using superficial peels with 40%-70% alpha hydroxy acids as comedolytic therapy.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Dermatologic Applications of Photodynamic Therapy
Photodynamic therapy may be considered medically necessary for non-hyperkeratotic actinic keratoses of the face and scalp, non-hyperkeratotic actinic keratoses of the upper extremities, low-risk (eg superficial and nodular) basal cell skin cancer only when surgery and radiation are contraindicated, and cutaneous squamous cell carcinoma in situ (Bowen disease) only when surgery and radiation are contraindicated. It is investigational for other dermatologic uses, including acne vulgaris, high-risk basal cell carcinomas, hidradenitis suppurativa, and mycoses, and for skin rejuvenation, hair removal, or other cosmetic indications. The 05/29/2026 update reviewed the policy with the policy statements unchanged and updated the code reference to note the deleted HCPCS code J7309.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.08.08h, Chemical Peels
Independence Blue Cross has reissued policy 11.08.08h on chemical peels with no substantive coverage changes. The policy maintains that dermal chemical peels (CPT 15789, 15793) for actinic keratoses and premalignant skin lesions are medically necessary only when more than 10 lesions are present AND topical 5-FU or imiquimod has failed or is contraindicated. Epidermal chemical peels (CPT 15788, 15792) remain not covered for these conditions, and all cosmetic peels are excluded.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code L57.0?

There are 18 tracked policy changes affecting code L57.0, including updates from Aetna, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code L57.0?

Payers that have issued tracked updates for code L57.0 include: Aetna, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when code L57.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code L57.0. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code L57.0?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Benign Skin Lesion Removal (CPB 0633, reviewed 2025-09-25)

Light and Laser Therapies for Dermatologic Conditions 8.01.21

Dermabrasion

MA11.103c, Chemical Peels

MA11.103c, Chemical Peels

Benign Skin Lesion Removal (CPB 0633, reviewed 2026-09-09)

Pulsed Dye Laser Treatment (CPB 0559, reviewed 2026-09-18)

Actinic Keratoses Treatments (CPB 0567, reviewed 2026-08-21)

Carbon Dioxide Laser (CPB 0427, reviewed 2026-07-08)

Dermabrasion, Chemical Peels, and Acne Surgery (CPB 0251, reviewed 2026-04-15)

Pulsed Dye Laser Treatment (CPB 0559, reviewed 2025-08-22)

Photodynamic Therapy (CPB 0375, reviewed 2026-05-21)

Cosmetic Surgery and Procedures (CPB 0031, reviewed 2026-06-25)

Optical Coherence Tomography of the Head and Neck (CPB 0928, reviewed 2025-12-30)

Actinic Keratoses Treatments (CPB 0567, reviewed 2026-04-10)

Chemical Peels

Dermatologic Applications of Photodynamic Therapy

11.08.08h, Chemical Peels

What insurance policy changes affect code L57.0?

Which payers have updated policy for code L57.0?

How do I get notified when code L57.0 policy changes?

Why do payers change policies for code L57.0?