DESCRIPTION
A chemical peel refers to a controlled removal of varying layers of the epidermis and superficial dermis. Chemicals, such as various acidic and basic chemical agents, are used to exfoliate the skin. The level of penetration, the nature of destruction, and the inflammatory response determines the level of the peel. The most common use of chemical peels is for the cosmetic treatment of photoaged skin. Chemical peels are also used as a comedolytic therapy for multiple actinic keratoses and for various stages of acne. Comedones are the plugs that form in pores.
Chemical epidermal peels are used to remove fine, subtle lines, soften the appearance of enlarged pores, improve the skin texture, and lighten hyper-pigmentary disorders.
Chemical dermal peels are used to treat deep wrinkles, actinic damage, or actinic keratoses. Acne scars have also been treated with dermal peels, but dermabrasion may be more effective for individuals with deep scarring.
POLICY
Epidermal chemical peels for the treatment of active acne are considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Dermal chemical peels for the treatment of numerous actinic keratoses are considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Epidermal chemical peels for the treatment of photoaged skin, wrinkles, or acne scars and dermal chemical peels for the treatment of end-stage acne scars are considered not medically necessary.
See also: Dermabrasion
MEDICAL APPROPRIATENESS
Chemical peels are considered medically appropriate if ANY ONE of the following are met:
Epidermal chemical peels with ALL of the following:
Used for the treatment of active acne
The individual has failed therapy such as topical and/or oral antibiotic acne therapy
An evaluation determines that the treatment rationale is not primarily cosmetic
Dermal chemical peels with ALL of the following:
Used for the treatment of numerous actinic keratoses
Treatment of the individual lesions is impractical due to having more than 10 actinic keratoses
Suspicious lesions have been biopsied to rule out basal cell carcinoma
An evaluation determines that the treatment rationale is not primarily cosmetic
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2011). Chemical peels (8.01.16). Retrieved September 13, 2011 from BlueWeb. (10 articles and/or guidelines reviewed)
Complete Guide to Medicare Coverage Issues [Computer software]. (2011, August). Treatment of actinic keratosis (NCD 250.4, p. 2-208). Ingenix.
Institute for Clinical Systems Improvement. (2006). Health Care Guideline: Acne management. Third edition. Retrieved June 2, 2009 http://www.icsi.org/acne__for_patients___families__17995/acne_management__for_patients___families__2.html.
Strauss, J. S., Krowchuk, D. P., Leyden, J. J., Lucky, A. A., Shalita, A. R., Siegfried, E. S., et al. (2007). Guidelines of care for acne vulgaris management. Journal of the American Academy of Dermatology, 56 (4), 651-663.
ORIGINAL EFFECTIVE DATE: 1/11/1983
MOST RECENT REVIEW DATE: 11/13/2011
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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