Q82.5 Insurance Policy Changes

ICD-10 Q82.5 is officially defined as "Congenital non-neoplastic nevus." code Q82.5 is referenced in 12 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 Q82.5 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.
Independence Blue Cross · Effective Apr 1, 2026Medium impact
MA11.071b, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
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 · Effective Apr 1, 2026Medium impact
11.08.04i, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
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.
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 Aug 19, 2026Medium impact
YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)
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 · Identified Aug 16, 2026Medium impact
Lymphangioma and Infantile Hemangioma (CPB 0817, reviewed 2025-12-03)
Treatment of hemangiomas of infancy is medically necessary when the lesion compromises vital structures such as the nose, eyes, ears, lips or larynx, is associated with Kasabach-Merritt Syndrome, is symptomatic, or results in a documented functional impairment, using cryosurgery or cryotherapy, embolization, intralesional steroids, laser therapy, radiotherapy, sclerosing therapy or surgical excision alone or in combination. Oral propranolol for proliferating infantile hemangioma requiring systemic therapy (corticosteroids) is medically necessary, and inpatient initiation is medically necessary for infants 8 weeks or younger (corrected age), infants without adequate social support, and infants with co-morbid cardiovascular, airway or blood glucose conditions. Atenolol, pigment epithelium-derived factor, topical timolol, C19MC microRNA and serum VEGF biomarker measurements, and sirolimus for diffuse intestinal infantile hemangioma 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
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 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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Laser Treatment of Congenital Port Wine Stain Hemangiomas
Laser treatment of port wine stains in the presence of functional impairment may be considered medically necessary, and removing nodular hemangiomas that develop in a previously flat port wine stain is considered medically necessary in children and adults. Coverage decisions should be based on the size and location of the lesions, since port wine stains are permanent and disfiguring when located on the face. Using a laser to remove decorative tattoos is considered cosmetic and is not medically necessary, and laser treatment combined with photodynamic therapy or topical angiogenesis inhibitors is considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Q82.5?

There are 12 tracked policy changes affecting code Q82.5, including updates from Aetna, Excellus BlueCross BlueShield, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Q82.5?

Payers that have issued tracked updates for code Q82.5 include: Aetna, Excellus BlueCross BlueShield, Independence Blue Cross, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code Q82.5 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Q82.5. 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 Q82.5?

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

MA11.071b, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)

11.08.04i, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)

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

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

YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)

Lymphangioma and Infantile Hemangioma (CPB 0817, reviewed 2025-12-03)

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

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

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

Laser Treatment of Congenital Port Wine Stain Hemangiomas

What insurance policy changes affect code Q82.5?

Which payers have updated policy for code Q82.5?

How do I get notified when code Q82.5 policy changes?

Why do payers change policies for code Q82.5?