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AetnaAll Plans · Coverage · Medical Policy · Dermatology, Plastic Surgery, Wound CareMedium impact

Hypertrophic Scars and Keloids (CPB 0389, reviewed 2026-05-28)

Effective date
Not stated in the notice
Identified
Aug 15, 2026

Summary

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.

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What to do

Action · 5 steps
01The billing team must meet these requirements when billing these services.
02For CPT 17110 (up to 14 lesions) and CPT 17111 (15 or more lesions), keloid destruction is covered for keloid scars documented as painful, ulcerated, or pruritic causing a functional impairment (restricted movement).
03For CPT 11900 and 11901, intralesional corticosteroids for keloids are covered where the medical necessity criteria for keloid removal are met, and the policy refers to CPB 0031 for those indications.
04For CPT 0479T and 0480T, fractional ablative laser for burn, traumatic, or post-surgical scars requires documented evidence of significant functional impairment related to the scar (limited movement) and documentation that conventional treatments such as hypoallergenic paper tape or silicone gel/sheeting were tried and failed.
05The experimental, investigational, or unproven interventions listed in the policy are not covered for hypertrophic scars or keloids.

Codes mentioned

17110171111190011901J0702J1020J1030J1040J1100J1700J1710J1720J2650J3300J3301J3302J3303J7638J9190L90.5L91.0

Original notice

Hypertrophic Scars and Keloids (CPB 0389, reviewed 2026-05-28)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesDermatologyPlastic SurgeryWound CareCode 17110Code 17111Code 11900Code 11901Code J0702Code J1020Code J1030Code J1040Code J1100Code J1700Code J1710Code J1720Code J2650Code J3300Code J3301Code J3302Code J3303Code J7638Code J9190Code L90.5Code L91.0

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