Does Insurance Ever Cover Laser Hair Removal?
With all the life-changing impacts associated with laser hair removal, clients often must pay for the service out of pocket. Clients with a medical diagnosis can also request reimbursement for laser hair removal treatments.
Regardless of the reason, most trips to the doctor or hospital are stressful.
And an unfortunate reality is physical wellbeing is only one component of that stress. Any doctor visit, major or minor, is an expensive endeavor.
Some people are lucky enough to ease some or all of that financial burden with insurance. Surgeries are more affordable. Long-term health issues are easier to withstand. Prescription costs are reduced.
Unfortunately, not all health conditions will fall under an insurance umbrella.
Which brings us to the focal point of this blog. Does insurance ever cover laser hair removal? Read on to find out.
What about a condition like PCOS (Polycystic Ovary Syndrome)? Is that ever covered?
Yes and no. There has been a success rate in getting those with PCOS reimbursed, but it has to do with the symptoms of PCOS because PCOS is technically an ObGyn issue.
If someone shows no signs or symptoms of hirsutism, the excessive hair growth that happens often with women, then it’s not medically necessary.
But hirsutism is not only a diagnosis for women. Men may also be diagnosed with the condition.
Again, the medical record needs to reflect prior therapy. What are they doing to treat that excessive hair? Have they used hair removal creams? Have they tried electrolysis? Have they been put on oral contraceptives? What are they doing to help tone down the excessive hair growth?
It’s not always the PCOS causing excessive hair growth to justify laser hair removal. It’s the hirsutism, the ingrown hairs, the scarring, or the discoloration of the skin due to PCOS.
Clients are often asked about how prior therapies can help support the new laser hair removal therapy. However, if the ICD-10 codes aren’t reflected in the referring provider’s medical record or the letter of medical necessity, insurance may be denied because there’s no medical necessity.
Many pieces have to fall into place for insurance to consider reimbursement …
What are ICD-10 codes?
International Classification of Diseases, Tenth Revision (also known as an ICD-10 code) is a system used to classify and code all diagnoses, symptoms, and procedures for claims processing.
Insurance requires these codes.
Sometimes, people can get an FSA (Flexible Spending Account) to cover it. Laser hair removal is typically considered cosmetic and not covered by an HSA. They have to get an exemption for that, and it’s kind of like the insurance gap exemption for out-of-network benefits. If they don’t have it documented, approval from the HSA for that exception is generally not granted or reimbursable.
ICD-10 codes take the diagnosis into a coding format similar to a procedure code. The procedure code for laser hair removal currently is CPT 17999. That 17999 code is unlisted because the American Medical Association has not assigned a specific procedure code to laser hair removal generally being considered by insurance to be a cosmetic procedure versus therapeutic.
This is another reason most insurance companies – not all, but a majority – require prior authorization. The initial authorization is what gives the client potential insurance coverage. However, insurance can still deny coverage, even though they gave prior authorization if the referring provider’s medical record doesn’t support the diagnosis and a new therapy of laser hair removal.
It all goes back to prior therapy, such as prescription medications, home remedies, or treatment for ingrown hair issues. If shaving or at-home devices haven’t worked, that documentation needs to be reflected in the medical record from the referring provider, or detailed in the letter of medical necessity (LMN).
The letter of medical necessity refers to a procedure based on a prior diagnosis or therapy.
Referrals are when a provider puts in an order for a patient to see a specialist.
This authorization is also known as a preauth, predetermination, or utilization review.
All methods are to ensure that the insurance has benefits for the CPT code based on the diagnosis.
Many factors need to align with insurance reimbursement for laser hair removal.
Absolutely. And it can be overwhelming.
There’s plenty of information to digest on the subject. So much so that we need a second blog to cover it all. Be on the lookout for that very soon!