Policy Name Effective Date Updated Review Date
Dermatology
MP-011 Benign Skin Lesion Removal September 15, 2021 September 15, 2021 September 15, 2022
MP-060 CO2 (Carbon Dioxide) Fractional Ablative Laser Treatment for Burn Scars August 18, 2021 August 18, 2021 August 18, 2022
MP-014 Treatment of Congenital Hemangiomas (Port Wine Stains) September 15, 2021 September 15, 2021 September 15, 2022
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