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Laser Treatment of Psoriasis or Parapsoriasis

Reimbursement Policy:
Laser Treatment of Psoriasis or Parapsoriasis

Effective Date:
November 16, 2020

Purpose:
To provide guidelines for the processing of 96920-96922 (Laser treatment of inflammatory skin disease [psoriasis]) when billed without a diagnosis of psoriasis or parapsoriasis.

Scope: All products are included, except

  • Products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap).
  • COB
  • ITS Home In-Network
  • FEP
  • SHBP non MA

All Insured Individual, Commercial medical plans, Medicare Advantage Plans, and SHBP are included.

Other ASO accounts will be included as an Opt-In option for additional claims editing on an account by account basis

Policy:
According to the AMA CPT Manual and CMS policy, laser treatment of psoriasis (96920-96922) should only be reported with a diagnosis of psoriasis (ICD-10 codes L40.0-L40.4, L40.8-L40.9) or parapsoriasis (ICD-10 codes L41-L41.9). Therefore, the laser treatment shall not be considered for reimbursement when one of these diagnoses is not present on the claim.

The procedure codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.

Procedure:
Horizon BCBSNJ shall deny 96920-96922 (laser treatment of inflammatory skin disease [psoriasis]) when billed without a diagnosis of psoriasis or parapsoriasis as provided above.

No additional reimbursement shall be made if the provider is capitated or the reimbursement structure for that provider is a global fee.

In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.

In instances where the provider is not participating, member liability shall be up to the provider’s charge.

Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.

History:
06/22/2020: Policy approved

Policy133_V1.0_06222020