ICD-10 L70.9 is officially defined as "Acne, unspecified." code L70.9 is referenced in 11 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code L70.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
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 The policy removes outdated ICD-9 codes from the code reference section.
Aetna considers infrared coagulation medically necessary for anal dysplasia and for members with grade I, II, or III internal hemorrhoids that are painful or persistently bleeding. Low-level infrared light therapy is considered experimental, investigational, or unproven for a long list of indications, including osteoarthritis, migraines, stroke, and diabetes mellitus, and the infrared glove is unproven for Raynaud's syndrome and all other indications. CPT 46930 is covered when selection criteria are met, while CPT 97026 and HCPCS codes A4639 and E0221 are not covered for the listed indications.
Aetna considers phototherapy and photodynamic therapy treatments for acne experimental, investigational, or unproven for acne vulgaris because of insufficient evidence of effectiveness in comparison with established treatments. The listed treatments include the ClearLight Acne PhotoClearing System, Omnilux Blue Photo Dynamic Therapy, laser therapy such as the AviClear Laser System, intense pulsed light, light-emitting diode therapy, photopneumatic therapy, and home-based devices, along with several other light, laser and photodynamic therapy approaches. Aetna also considers laser therapy, photodynamic therapy with topical 5-ALA or Levulan, and phototherapy experimental, investigational, or unproven for acne inversa (hydradenitis suppurativa), and considers combined surgery and photodynamic therapy experimental for cystic acne of the scalp.
Aetna considers Nd:YAG laser capsulotomy medically necessary after cataract extraction in members with visually significant clouding of the posterior capsule, and considers Nd:YAG laser peripheral iridotomy medically necessary for acute primary angle closure, primary angle-closure glaucoma, plateau iris syndrome, aqueous misdirection, and before intraocular lens insertion into the anterior chamber to avoid post-operative iris bombe or pupil block. Capsulotomy performed within 6 months of cataract surgery is subject to medical necessity review, and it is considered experimental, investigational, or unproven if none of the stated criteria is met. Nd:YAG laser vitreolysis for vitreous floaters, posterior hyaloidotomy for pre-macular hemorrhage, goniopuncture for failed trabeculectomy, and peripheral iridotomy to prevent pigment dispersion glaucoma are considered experimental, investigational, or unproven, as are many non-ophthalmological uses such as basal cell carcinoma, benign prostatic hyperplasia, onychomycosis and snoring.
Aetna considers a list of tests experimental, investigational, or unproven because CMS has determined they are obsolete or unreliable, they have been replaced by more advanced procedures, or professional specialty societies do not recommend them, and the list includes the lupus erythematosus cell test, cardiointegram, and several serum and skin tests. Aetna also considers a set of obsolete procedures experimental, investigational, or unproven, including colectomy to treat epilepsy, mammary artery ligation for coronary artery disease, optic nerve decompression for non-arteritic anterior ischemic optic neuropathy, radiation therapy for acne, Ali Krogius procedure for patellofemoral instability, and visceral osteopathy. Each listed test or procedure has CPT, HCPCS, or ICD-10 codes that are not covered for the indications the policy names.
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 considers the light, laser and photodynamic treatments for acne vulgaris listed in this policy experimental, investigational or unproven, because evidence of effectiveness compared with established treatments is insufficient. The list includes the ClearLight and Omnilux Blue systems, the AviClear laser, intense pulsed light, light-emitting diode therapy, photopneumatic therapy, the CellFX nano-pulse system, and home-based devices that deliver heat, light, laser, suction or ultraviolet therapy. Aetna also considers laser therapy, PDT with topical 5-ALA or Levulan, and phototherapy experimental for acne inversa (hidradenitis suppurativa), and combined surgery and PDT experimental for cystic acne of the scalp. The policy lists the CPT, HCPCS and ICD-10 codes in its code table as not covered for the indications it names, including L70.0 through L70.9 for acne and L73.2 for hidradenitis suppurativa.
Serum free testosterone (CPT 84402) is medically necessary to distinguish a sex hormone-binding globulin (SHBG) abnormality from hypogonadism in obese males with symptoms of hypogonadism when total testosterone is low, to diagnose hyperandrogenism in symptomatic females, and in patients with a medical diagnosis that may increase or decrease SHBG levels. It is not medically necessary to diagnose testosterone deficiency in non-obese males with symptoms of hypogonadism, or when performed for screening of asymptomatic patients. Free testosterone should be performed by equilibrium dialysis, and free testosterone measured by an analog method should never be ordered.
Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism, to diagnose hyperestrogenism in symptomatic males, to monitor hormone replacement therapy in postmenopausal females, and to monitor antiestrogen therapy. Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients. The covered tests are total estradiol (CPT 82670), fractionated estrogens (CPT 82671), total estrogens (CPT 82672), estrone (CPT 82679), and free estradiol by direct measurement, such as equilibrium dialysis (CPT 82681).
This is a reissue of Independence Blue Cross Medicare Advantage Policy MA11.109a confirming the Company's continuing position that laser therapy, electrosurgery, cryosurgery, and chemosurgery for treatment of active acne are NOT covered (experimental/investigational), and services for acne scarring are NOT covered (cosmetic). No substantive policy changes have been made; this is a routine review and reissue.
Independence Blue Cross has reissued MA11.109a to reaffirm that laser therapy, electrosurgery, cryosurgery, and chemosurgery (chemical peels) for treating active acne vulgaris remain non-covered as experimental/investigational procedures under Medicare Advantage plans. These same procedures for acne scarring remain non-covered as cosmetic services. This is a reaffirmation of the Company's continuing position with no substantive changes to coverage criteria.
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