BlueCross BlueShield of Tennessee Medical Policy Manual

Hair Removal


The procedure applies to the permanent removal of hair (decompensating a hair follicle) anywhere on the body by electrolysis, use of a laser, or any other technique.




Alster, T., Garden, J., Fitzpatrick, R., Rendon, M., Sarkany, M., & Adelglass, J. (2014). Lidocaine/tetracaine peel in topical anesthesia prior to laser-assisted hair removal: phase-II and phase-III study results. Journal of Dermatological Treatment, 25 (2), 174-177. Abstract retrieved April 29, 2016 from PubMed database.

Asilian, A., Shahmoradi, Z., Mazloomi, R., & Nilforoushzadeh, M. (2014). The effects and side effects of lidocaine tetracaine peel off on laser-assisted hair removal. Advanced Biomedical Research, 2014; 3: 110. (Level 3 evidence)

Gay-Escoda, C., Parraga-Manzol, G., Sanchez-Torres, A., & Moreno-Arias, G. (2015). Chronic neuropathic facial pain after intense pulsed light hair removal. Clinical features and pharmacological management. Journal of Clinical and Experimental Dentistry, 7 (4), e544-e547. (Level 4 evidence)

U. S. Food and Drug Administration. (2007, November). Center for Devices and Radiological Health. CDRH consumer information - Laser facts. Retrieved December 7, 2007 from

U. S. Food and Drug Administration. (2012, May). Center for Devices and Radiologic Health. 510(k) Premarket Notification Database. K120080. Retrieved September 4, 2012 from 




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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