Is Microdermabrasion Covered by Insurance?
Considering microdermabrasion? Learn if your health insurance covers this skin treatment, especially when medically necessary.
Microdermabrasion is a cosmetic procedure aimed at improving skin texture and appearance. Understanding health insurance coverage for such treatments, and potential out-of-pocket expenses, requires distinguishing between those for aesthetic enhancement and those deemed medically necessary.
Understanding Insurance Coverage for Cosmetic Procedures
Health insurance distinguishes between procedures for aesthetic reasons and those considered medically necessary. Cosmetic procedures, like microdermabrasion, are not covered because their primary purpose is to enhance appearance rather than treat an illness or injury. Procedures improving skin texture, tone, or reducing signs of aging, without an underlying medical condition, fall into the cosmetic category.
The intent behind the treatment determines its classification by an insurance provider. If a procedure is elected purely for personal preference to improve appearance, it is considered elective and not eligible for coverage. Insurance companies classify microdermabrasion as an elective cosmetic procedure, making it unlikely to be covered.
When Microdermabrasion May Be Covered
While microdermabrasion is considered cosmetic, a related, more intensive procedure called dermabrasion may be covered under specific medical conditions. Dermabrasion involves deeper exfoliation and is distinct from microdermabrasion. Insurance may cover dermabrasion if it is medically necessary to address certain skin conditions, such as actinic keratoses or localized non-melanoma malignant skin lesions like basal cell carcinoma.
Dermabrasion may also be considered for severe acne scarring if it leads to functional impairment or significant disfigurement, though coverage for scarring is often denied. The procedure must be part of a prescribed treatment plan by a dermatologist or plastic surgeon. Medical documentation is required to demonstrate the treatment addresses a diagnosed medical condition, detailing how the condition causes functional impairment or health risk.
Steps to Verify Your Coverage
To determine if your microdermabrasion or dermabrasion procedure is covered, review your insurance policy documents. These outline covered services, costs, deductibles, or co-pays. Many providers also offer online portals to search for coverage details.
Contact your insurance company directly using the customer service number on your insurance card. Inquire about coverage for the specific procedure, providing relevant CPT codes if your doctor supplied them. For dermabrasion, codes like 15780, 15781, or 15782 apply for medically necessary cases, though microdermabrasion lacks a specific CPT code and may be considered unlisted.
Ask about pre-authorization requirements, as medically necessary procedures require prior approval. Your healthcare provider’s office can assist with submitting pre-authorization requests and providing medical documentation.