Shine a Light on Ablative Fractional Laser Treatment Coding
- By Renee Dustman
- In Billing
- November 1, 2021
- Comments Off on Shine a Light on Ablative Fractional Laser Treatment Coding
TRICARE adds laser skin resurfacing to five-year provisional coverage policy.
Of particular interest to dermatologists, a recent revision to TRICARE’s provisional coverage for emerging services and supplies adds ablative fractional laser (AFL), including carbon dioxide (CO2) laser and Erbium YAG (Er:YAG) laser, treatment for symptomatic scars resulting from burns and other trauma.
Effective dates are Feb. 24, 2021, to Feb. 23, 2026. Preauthorization is not required, but you will need to know coverage guidelines for AFL to get claims paid.
What Is an AFL Treatment?
Laser resurfacing is often used for cosmetic purposes to improve the appearance of skin blemishes caused by aging and sun damage. An ablative laser wounds the outer layer of skin (epidermis) and heats the underlying layer of skin (dermis). This process stimulates new collagen, which restores skin elasticity. A fractional laser leaves portions of the treatment area untouched, as shown in the accompanying illustration, which shortens recovery time. More recently, AFL studies show the efficacy for early treatment of burns and new scars. Non-ablative laser treatment is non-wounding and not as effective as ablative laser treatment.
Coverage Guidelines for AFL
TRICARE is a major part of the Military Health System, servicing approximately 9.6 million beneficiaries. AFL is covered for TRICARE members with one or more of the following symptoms due to burns or scars:
- Itch
- Burn
- Pain
- Tightness
- Ulcerations
- Physical functional impairment
The TRICARE policy manual (6010.60-M) provides examples of “physical functional impairment,” including but not limited to:
- Decreased range of motion of associated body part
- Problems with talking, breathing, eating, swallowing
- Visual impairments
- Skin integrity
- Distortion of nearby body parts
- Obstruction of an orifice (body opening)
AFL treatments are not covered under TRICARE for social, emotional, and psychological impairment or potential impairments, and for purely cosmetic purposes (for exceptions, see TRICARE Policy Manual, Chapter 4, Section 2.1).
Coding and Billing AFL Treatments
TRICARE carriers — Humana Military (East) and Health Net (West) — will reimburse AFL treatments reported with the following codes when coverage parameters are met:
0479T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part thereof, or 1% of body surface area of infants and children
0480T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure)
CPT® guidelines state to report these codes only once per day. TRICARE Encounter Data (TED) code AT must be used to override the No Government Pay Procedure List edit, according to Humana Military.
Payment rates are in line with CPT® destruction codes
17280-17826. Member copays and deductibles apply.
Note: Other ongoing provisional care coverages under TRICARE are 3D mammography (Jan. 1, 2020-Dec. 31, 2024) and platelet-rich plasma injections (Oct. 1, 2019-Sept. 30, 2024).
Resources:
TRICARE Policy Manual 6010.60-M, “Provisional Coverage for Emerging Services and Supplies.” https://manuals.health.mil/pages/DisplayManualHtmlFile/2021-08-13/AsOf/TP15/C13S1_1.html
Meynkohn MD, Anna, et al. “Fractional Ablative Carbon Dioxide Laser Treatment of Facial Scars,” Journal of Cosmetic Dermatology. July 2021. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.13850
Humana Policy Updates and Alerts. Aug. 30, 2021. www.humanamilitary.com/provider/education-and-resources/quick-access/policy-updates-and-alerts/afl-083021
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