ICD-10 L90.5 is officially defined as "Scar conditions and fibrosis of skin." code L90.5 is referenced in 21 tracked payer policy changes from Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code L90.5 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross updated HCPCS coding for scar revision treatment effective 2026-10-01. Code J9190 (fluorouracil 500 mg) was deleted and replaced with two new codes: J9191 (fluorouracil avyxa, 10 mg) and J9192 (fluorouracil, 10 mg). Additionally, the narrative description for J3300 was revised to specify the brand name (triesence) for triamcinolone acetonide. These changes affect intralesional injection coding for keloidal and hypertrophic scar treatment.
Independence Blue Cross Medicare Advantage updated MA11.078e effective 10/01/2026 with HCPCS code changes for scar revision treatment. The deleted code J9190 (fluorouracil 500 mg) has been replaced with two new codes: J9191 (fluorouracil avyxa 10 mg) and J9192 (fluorouracil 10 mg). Additionally, J3300 narrative was revised to specify the brand name (triesence) for triamcinolone acetonide. Billing teams must update systems to stop billing the old fluorouracil code and begin using the new codes for intralesional injections in keloid and hypertrophic scar treatment.
Independence Blue Cross reissued MA11.071b on 04/01/2026 to reaffirm its coverage position on selective photothermolysis using pulsed-dye lasers (PDL). The policy clarifies that PDL treatment for psoriasis, molluscum contagiosum, basal cell carcinoma, cutaneous lupus erythematosus, and cutaneous sarcoidosis remains experimental/investigational and non-covered. The policy also updated criteria for rosacea treatment to align with current clinical standards and added specific ICD-10 diagnosis codes for non-covered indications.
Independence Blue Cross reissued Policy 11.08.04i on 04/01/2026 reaffirming its continuing position on PDL treatment coverage. The policy clarifies medically necessary indications (port wine stains, hemangiomas, hypertrophic/keloidal scars, pyogenic granulomas, viral warts, and rosacea), designates specific conditions as experimental/investigational (psoriasis, molluscum contagiosum, basal cell carcinoma, cutaneous lupus), and updates rosacea treatment criteria to require 6-month failed medical management before PDL coverage. Billing teams must verify patient diagnoses against the expanded ICD-10 code list and confirm medical necessity documentation for rosacea cases.
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 has removed 8 CPT codes (C5271-C5278) from the MA11.078e Scar Revision policy effective 01/01/2026. These codes are no longer valid for billing scar revision procedures under Medicare Advantage plans. The underlying coverage criteria for scar revision remain unchanged—procedures are covered when medically necessary (functional impairment, chronic pain, or part of reconstructive treatment plan) but excluded when purely cosmetic.
Independence Blue Cross removed 8 C-codes (C5271-C5278) from Policy 11.08.25o effective January 1, 2026. These codes are no longer recognized for scar revision procedures under this policy. Billing teams must verify whether these codes are still valid in CPT/HCPCS databases and confirm alternate coding before processing claims on or after the effective date.
Aetna's Clinical Policy Bulletin 0547 considers medical treatment of rosacea medically necessary, but surgical treatment of disfigurement from rosacea, such as scarring and telangiectasias, is considered cosmetic. Excision or shaving of rhinophyma is medically necessary only for bleeding or infection refractory to medical therapy, such as the need for repeated cautery of bleeding telangiectasias or frequent courses of antibiotics for pustular eruptions. Intense pulsed light for ocular rosacea, photodynamic therapy, platelet-rich plasma injection, and several rosacea biomarker and imaging tests are listed as experimental, investigational, or unproven.
Aetna clinical policy bulletin 0649 (reviewed September 14, 2026) considers extracorporeal shock-wave therapy medically necessary only for calcific tendinopathy of the shoulder that has lasted at least 6 months, has a calcium deposit of 1 cm or more, and has not responded to conservative care. It lists many other musculoskeletal, pain, wound and scar indications as experimental or not covered. The source gives a review date but no effective date, so confirm current applicability before changing workflows.
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 excimer and pulsed dye laser treatment medically necessary for persons with mild-to-moderate localized plaque psoriasis affecting 10% or less of body area who have failed to adequately respond to 3 or more months of topical treatments, including at least 3 of the listed agents. No more than 13 laser treatments per course and 3 courses per year are generally considered medically necessary, and additional courses are not considered medically necessary if the person fails to respond to an initial course, as documented by a reduction in PASI score or other objective response measurement. The policy also covers laser hair removal for recurrent pilonidal cyst, laser treatment for acne keloidalis nuchae and penile intraepithelial neoplasia, and Nd:YAG laser for hidradenitis suppurativa. Combined pulsed dye laser and UVB for localized plaque psoriasis, and excimer or pulsed dye laser for psoriasis other than plaque psoriasis, are considered experimental, investigational or unproven, as is laser treatment for the other listed skin conditions. Laser treatment for acne scarring, keratosis pilaris, pearly penile papules and rhinophyma is considered cosmetic.
Aetna considers medical treatment of rosacea medically necessary. Surgical treatment of disfigurement from rosacea, such as scarring and telangiectasias, is considered cosmetic, and cosmetic surgery is excluded from coverage under Aetna standard benefit plans. Aetna considers excision or shaving of rhinophyma medically necessary for bleeding or infection refractory to medical therapy, and considers intense pulsed light for ocular rosacea, photodynamic therapy, and platelet-rich plasma injection experimental, investigational or unproven.
Aetna Clinical Policy Bulletin 0389 sets the coverage rules for treating hypertrophic scars and keloids. It considers intralesional 5-fluorouracil, cryotherapy, or intralesional corticosteroids medically necessary for keloids when the medical necessity criteria for keloid removal are met, and fractional ablative laser for burn, traumatic, and post-surgical scars when there is documented significant functional impairment (limited movement) and conventional treatments such as hypoallergenic paper tape or silicone gel/sheeting have been tried and failed. The policy lists many other interventions as experimental, investigational, or unproven for these scars because their effectiveness has not been established, including silicone products, intense pulsed light, bevacizumab, intralesional botulinum toxin type A, and dermal substitutes.
Aetna considers burn garments and the associated physical and occupational therapy medically necessary when the burn is of documented significance to place the member at risk of a post-burn contracture, the garment and therapy are used to prevent skin grafting or contractures from hypertrophic scarring, and the garment is authorized by the primary care physician and/or treating specialist. Silon-TEX as an adjunct to pressure garment therapy, support garments for scar minimization of the donor site, and topical silicone gel as an adjunct to pressure garment therapy are considered experimental, investigational or unproven. Burn garments are durable medical equipment, and HCPCS codes A6501 through A6513 (custom-fabricated burn garments and burn masks) are covered when selection criteria are met, while HCPCS code A6025 (gel sheet) is not covered for use as an adjunct to pressure garment therapy.
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.
Aetna considers phonophoresis experimental, investigational, or unproven for all indications, including adhesive capsulitis, carpal tunnel syndrome, knee osteoarthritis, low back pain, neck pain, sinusitis, chronic obstructive pulmonary disease, and venous and diabetic ulcers, because its effectiveness has not been established. Controlled clinical trials have failed to demonstrate that phonophoresis increases the rate or extent of absorption of analgesics and anti-inflammatory agents. Bee venom phonophoresis and Contractubex phonophoresis are listed as not covered for the indications in the policy.
This Blue Cross Blue Shield policy states that benefits are specifically excluded when augmentation mammoplasty is performed for cosmetic purposes. Augmentation may be considered reconstructive in listed situations, including agenesis or severe hypoplasia with a 50% or greater deformity of the contralateral breast, scoliosis, Poland's syndrome, chest wall deformity such as pectus excavatum, breasts damaged by infection, traumatic loss, scarring, burns or X-ray therapy, and reconstruction after mastectomy for cancer. The 03/27/2026 policy update removed the ICD-9 procedure and diagnosis codes.
This is Aetna Clinical Policy Bulletin 0649, reviewed October 2, 2025 and first found by PolicyChanges in August 2026, so it is historical material and the current version should be confirmed before acting. Aetna covers extracorporeal shock-wave therapy only for calcific tendinopathy of the shoulder with a calcium deposit of at least 1 cm lasting 6 months or more after conservative care has failed, and lists dozens of other musculoskeletal, wound and medical uses as experimental, investigational or unproven.
Independence Blue Cross has reissued MA11.078c (now superseded by MA11.078e) confirming its continuing position on scar revision coverage for Medicare Advantage plans. The policy maintains that scar revision is covered only when medically necessary (functional impairment, chronic pain, or part of reconstructive treatment plan), while cosmetic scar revision remains a contract exclusion. No substantive coverage changes were made in recent updates; the policy was reviewed and reissued without modifications as of 10/29/2025.
Independence Blue Cross reissued Policy 11.08.25n (now superseded by 11.08.25o) on 10/29/2025 to communicate the company's continuing position on scar revision coverage. The policy clarifies that scar revision is covered when medically necessary (functional impairment, chronic pain, or part of reconstructive treatment) but remains a cosmetic exclusion otherwise. No substantive coverage changes were made; this is a routine policy reaffirmation.
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