Does Insurance Cover Microneedling?
Considering microneedling? Learn how insurance coverage is determined, what to look for in your policy, and how to prepare financially.
Microneedling is a minimally invasive skin procedure that uses fine needles to create tiny punctures in the top layer of the skin. This process, also known as collagen induction therapy, stimulates the body’s natural healing response. The micro-injuries encourage new collagen and elastin production, proteins that contribute to skin firmness and smoothness. While most commonly performed on the face, microneedling can address various skin concerns on other body areas.
Medical Versus Cosmetic Procedures
Understanding the distinction between medical and cosmetic microneedling is essential when considering insurance coverage. Cosmetic microneedling improves overall skin appearance, addressing fine lines, wrinkles, enlarged pores, or general skin texture without an underlying medical diagnosis. These procedures are considered elective and are not covered by health insurance policies. Insurance plans primarily cover treatments deemed medically necessary for the diagnosis, cure, mitigation, treatment, or prevention of a disease.
In contrast, medical microneedling addresses specific diagnosed skin conditions that cause functional impairment or significant disfigurement. Insurance providers classify treatments based on whether they restore function or alleviate a health issue, rather than solely enhancing appearance. Therefore, coverage hinges on a documented medical necessity and a physician’s diagnosis.
Qualifying Conditions for Coverage
Microneedling may be considered medically necessary when used to treat specific dermatological conditions. For instance, severe acne scarring that causes physical disfigurement or functional impairment could qualify for coverage. Similarly, certain types of burn scars or other significant scarring resulting from trauma or surgery might be deemed medically necessary.
A physician’s diagnosis and recommendation are crucial for establishing medical necessity. The treatment must be part of a broader medical plan to address a diagnosed condition, not merely for cosmetic improvement. The ultimate decision for coverage rests on the individual insurance policy’s terms and the carrier’s medical necessity criteria. Even with a qualifying condition, coverage is not guaranteed and requires careful verification.
Checking Your Insurance Policy
To determine if your microneedling procedure might be covered, begin by thoroughly reviewing your insurance policy documents. Pay close attention to sections related to dermatological services, cosmetic exclusions, and medically necessary treatments, especially language regarding scar revision or reconstructive procedures.
Next, contact your insurance provider directly using the member services number on your insurance card. Clearly state you are inquiring about coverage for a “medically necessary dermatological procedure” or “scar revision,” rather than a cosmetic one. Request the specific diagnostic codes (ICD-10) and procedure codes (CPT) your physician plans to use, then ask the insurer if these codes are covered and under what conditions. Inquire about pre-authorization requirements, as many medically necessary procedures need prior approval to ensure coverage. Understanding your deductible, co-payment, and co-insurance obligations is also important, as these out-of-pocket costs will apply even if the procedure is covered.
Considering Out-of-Pocket Expenses
When insurance coverage is not available or the procedure is deemed cosmetic, individuals are responsible for the full cost of microneedling treatments. The typical cost for a single microneedling session ranges from $200 to $800. Advanced treatments, such as those combining microneedling with radiofrequency (RF) or platelet-rich plasma (PRP), can increase the per-session cost, potentially ranging from $1,500 to $2,500.
Most individuals require multiple sessions to achieve desired results, with recommendations ranging from three to six sessions, sometimes up to eight, spaced four to six weeks apart. This means total out-of-pocket expenses can accumulate significantly, potentially ranging from $600 to over $10,000 depending on the type and number of sessions. Factors influencing the overall cost include the provider’s expertise, geographic location, the size of the treatment area, and any additional serums or technologies used. Health savings accounts (HSAs) or flexible spending accounts (FSAs) may be used for medically necessary microneedling, but not for purely cosmetic purposes.