Medical Policy Revision: Chemical Peels

Effective February 15, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for chemical peels.

According to the guidelines of our medical policy, Chemical Peels (formerly titled Chemical Peels for Actinic Keratoses):

• Dermal chemical peels for the treatment of members with numerous (greater than 10) actinic keratoses, or other premalignant skin lesions such that treatment of the individual lesions becomes impractical, is considered medically necessary.
• Epidermal chemical peels used to treat members with active acne that has failed a trial of topical and/or oral antibiotic acne therapy are considered medically necessary. In this setting, superficial chemical peels with 40 to 70 percent alpha hydroxy acids are used as a comedolytic therapy. (Alpha hydroxy acids can also be used in lower concentrations [8 percent] without the supervision of a physician.)
• Epidermal chemical peels used to treat photoaged skin, wrinkles, acne scarring or dermal peels used to treat end-state acne scarring are considered cosmetic and not medically necessary.

We strongly encourage you to review the entire policy in our online Medical Policy Manual.

Based on the guidelines of our medical policy, Chemical Peels, AND the submitted diagnosis code(s):

• CPT® code 17360 submitted on claims for services provided on and after February 15, 2016 may be denied as not medically necessary.
• Claims for services provided on and after February 15, 2016 that include CPT codes 15788, 15792 or 17360 may pend while information to determine medical appropriateness is requested and reviewed.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after February 15, 2016.

CPT® is a registered mark of the American Medical Association.