Cantharidin (Ycanth) (CPB 1051, reviewed 2025-12-23)

REQUIREMENTS: - Immediately: Billing team must update claims submission system to recognize HCPCS code J7354 (cantharidin topical, 0.7%, single unit dose applicator) as a covered service under Aetna commercial plans when ICD-10 diagnosis B08.1 (molluscum contagiosum) is present. - Immediately: Implement pre-claim validation rules in billing software to enforce ALL approval criteria before processing: (1) member age ≥2 years, (2) diagnosis of molluscum contagiosum, (3) lesion type excludes oral/mucosal/ophthalmic areas, (4) maximum 2 applicators per single treatment session, and (5) maximum 4 treatment sessions total per infection. - Before first claim submission: Verify that providers administering Ycanth have documented training and instruction completion in member records; claims may be denied if provider credentials cannot be verified. - Update billing software to deny or flag claims exceeding 4 treatment cycles (sessions) for the same molluscum infection, as these are considered experimental/investigational. - Flag any claims for patients under 2 years of age and route to medical review; these are not covered. - Inform providers that CPT codes 17110 and 17111 (lesion destruction) should NOT be billed concurrently with J7354 for the same molluscum treatment session; verify billing intent before claim submission. - Add coverage criteria checklist to encounter templates for dermatology/primary care staff to ensure all documentation is captured prior to billing. - Failure to implement these controls will result in claim denials for non-compliance with coverage criteria.