Medical Policy

Effective Date:12/07/2005 Title:Excimer Laser in Psoriasis
Revision Date:09/01/2016 Document:BI125:00
CPT Code(s):96920, 96921, 96922
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

The excimer laser is a light therapy used to treat small areas of psoriasis that have not responded to at least three months of other forms of therapy. It is not practical to treat more than 10% of body surface area with the laser.

 

Excimer Laser treatment requires pre-authorization.

Medical Statement

Excimer laser treatment is eligible for benefits for persons with mild to moderate localized plaque psoriasis (L40.0, L40.8) affecting 10% or less of their body area who have failed to adequately respond to methotrexate and three or more months of topical treatments, with three or more of the following: HAYES C

  1. High potency corticosteroids (examples include Fluocinonide cream and betamethasone dipropionate ointment);
  2. Vitamin D derivatives: calcipotriene;
  3. Retinoids: tazarotene;
  4. Anthralin;
  5. Tar preparations; and/or
  6. Keratolytic agents: salicylic acid, lactic acid, urea.

Codes Used In This BI:

96920             Laser treatment for inflammatory skin disease (psoriasis); total area less                            than 250 sq cm

96921             Laser treatment for inflammatory skin disease (psoriasis); 250 - 500 sq cm

96922             Laser treatment for inflammatory skin disease (psoriasis); over 500 sq cm

Limits

No more than 13 laser treatments per course and three courses per year are generally considered medically necessary. Preauthorization may be requested and/or granted by treatment or by treatment course.


Additional courses are not covered if the person fails to respond to an initial course of laser therapy, as documented by a reduction in Psoriasis Area and Severity Index (PASI) score or other objective response measurement.

Reference

1.    Asawanonda P, Anderson RR, Chang Y, Taylor CR. 308-nm excimer laser for the treatment of psoriasis: A dose-response study. Arch Dermatol. 2000; 136(5):619-624. Available at: http://www.photomedex.com/media/308nm.pdf .

2.    Kemény L, Bónis B, Dobozy A, et al. 308-nm excimer laser therapy for psoriasis. Arch Dermatol. 2001; 1371):95-96.

3.    Asawanonda P, Anderson RR, Taylor CR. Pendulaser carbon dioxide resurfacing laser versus electrodessication with curettage in the treatment of isolated, recalcitrant psoriatic plaques. J Am Acad Dermatol. 2000; 42(4):660-666.

4.    Boehncke WH, Ochsendorf F, Wolter M, Kaufmann R. Ablative techniques in Psoriasis vulgaris resistant to conventional therapies. Dermatol Surg. 1999; 25(8):618-621.

5.    U.S. Food and Drug Administration. 510(k) Summary. PhotoMedex Inc. XTRAC Excimer Laser System, model AL 7000. 510(k) No. K003705. Rockville, MD: FDA; March 1, 2001. Available at: http://www.fda.gov/cdrh/pdf/k003705.pdf .

6.    Griffiths CEM, Clark CM, Chalmers RJG, et al. A systematic review of treatments for severe psoriasis. Executive Summary. Health Technol Asses. 2000; 4(40). Available at: http://www.ncchta.org/execsumm/summ440.htm.

7.    Feldman SR, Mellen BG, Housman TS, et al. Efficacy of the 308-nm excimer laser for treatment of psoriasis: Results of a multicenter study. J Am Acad Dermatol. 2002; 46(6):900-906.

8.    Hayes; Laser Therapy for Psoriasis, June 24, 2003

9.    Feldman SR. Remissions of psoriasis with excimer laser treatment. Dermatol Online J. 2003; 8(2):23.

10.  Rodewald EJ, Housman TS, Mellen BG, Feldman SR. Follow-up survey of 308-nm laser treatment of psoriasis. Lasers Surg Med. 2002; 31(3):202-206.

11.  Rodewald EJ, Housman TS, Mellen BG, Feldman SR. The efficacy of 308 nm laser treatment of psoriasis compared to historical controls. Dermatol Online J. 2003; 7(2):4.

12.  Taneja A, Trehan M, Taylor CR. 308-nm excimer laser of the treatment of psoriasis. Induration-based dosimetry. Arch Dermatol. 2003; 139(6):759-764.

 

Addendum:

Effective 10/01/2017: Added requirement for not responding adequately to oral methotrexate.

Resource Document:

BI125 Excimer Laser for Psoriasis

 

Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.

Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.