Policy Name Effective Date Updated Review Date
Dermatology
MP-011 Benign Skin Lesion Removal August 16, 2020 August 16, 2020 August 16, 2021
MP-060 CO2 (Carbon Dioxide) Fractional Ablative Laser Treatment for Burn Scars October 26, 2020 August 26, 2020 August 26, 2021
MP-014 Treatment of Congenital Hemangiomas (Port Wine Stains) September 16, 2020 September 16, 2020 September 16, 2021
MP-057 Genetic Testing for Melanoma October 26, 2020 August 26, 2020 August 26, 2021
MP-048 Phototherapy, Photochemotherapy or PUVA, and Excimer Laser Therapy for Dermatologic Conditions October 21, 2020 October 21, 2020 October 21, 2021