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.
The removal of hair by means of electrolysis, laser, or any other technique is considered cosmetic.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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.
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 http://www.fda.gov.
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 http://www.accessdata.fda.gov.
ORIGINAL EFFECTIVE DATE: 6/1998
MOST RECENT REVIEW DATE: 3/28/2019
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.
This document has been classified as public information.