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Chemical peels can be subdivided into the types of wounding agents used and the depth of the peel-either epidermal or dermal. However, the common mechanism of action is exfoliation of the skin followed by re-epithelization generating from the eipthelial appendages and adnexal structures. The most common wounding agents are various preparations of phenol (i.e., Baker's solution), trichloroacetric acid (TCA), Jessner's solution, (i.e., resorcin, salacylic and lactic acid), and alpha hydroxy acids.

An epidermal peel may be used to remove fine, subtle lines, soften the appearance of enlarged pores, improve the skin texture, and lighten hyperpigmentary disorders. Multiple epidermal peels (also referred to as chemical exfoliation) may also be used as a comedolytic therapy in patients with active acne. (A prominent manifestation of acne is the open or closed comedo, which refers to a plug of keratin and sebum within the dilated hair follicle. Disruption of the follicular wall with exposure of the sebum and keratin to the dermis produces the characteristic inflammatory lesions of acne.)

Dermal peels may be used to treat deep wrinkling, actinic damage, or actinic keraotoses. Acne scarring has also been treated with dermal peels, but dermabrasion may be more effective in patients with deep scarring. After dermal peels, the treated areas will develop marked edema and erythema with a profuse exudate. Post-dryness and itching develop between 7 and 10 days. The erythema usually takes 6 to 8 weeks to resolve.

Epidermal chemical peels used to treat photo-aged skin, wrinkles, or acne scarring is considered cosmetic.

Dermal chemical peels as a treatment of end-stage acne scarring is considered cosmetic. 

Dermal chemical peels used to treat patients with numerous (greater than 10) actinic keratoses or other premalignant skin lesions, such that treatment of the individual lesions becomes impractical, may be considered medically necessary.

Epidermal chemical peels used to treat patients with active acne that have failed a trial of topical and/or oral antibiotic acne therapy are considered medically necessary. In this setting superficial chemical peels with 50%-70% alpha hydroxy acids are used as a comedolytic therapy. (Alpha hydroxy acids can also be used in lower concentrations [8%] without the supervision of a physician.)

A related medical policy is Dermabrasion.  

None

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

5/1998: Policy revision approved by MPAC; policy renamed Chemical Peels

3/19/2002: "Review on an individual basis" requirement deleted

4/18/2002: Type of Service and Place of Service deleted

9/4/2002: Policy section revised

11/5/2003: Code Reference section updated, CPT 15792, 15793 moved from covered to non-covered

6/15/2004: Code Reference section updated, CPT 15792, 15793 moved from non-covered to covered, ICD-9 diagnosis code 232.0, 232.1, 232.2, 232.3, 232.4, 232.5, 232.6, 232.7, 232.8, 232.9, 238.2 added to covered codes, Non-covered table deleted, Sources updated

1/7/2009: Policy reviewed, no changes

06/22/2010:  Policy statement revised to state that dermal chemical peels as a treatment of end-stage acne scarring is considered cosmetic. Deleted the following policy statement: Treatment of hyperpigmentation is medically necessary only when it is secondary to previous medical
treatment originally performed for medically necessary, not cosmetic reasons. Due to the policy statement changes, ICD-9 codes 374.52, 695.3, 701.4, 709.00, 709.09, and 709.2, which describe hyperpigmentation and end-stage acne scarring, were deleted from the Covered Codes table. Policy guidelines updated regarding evaluation for cosmetic versus medically necessary treatment. Deleted outdated references from the Sources section.

07/16/2010: Policy reviewed; no changes.

08/03/2011: Policy reviewed; no changes.

09/25/2012: Policy reviewed; no changes.

The code(s) listed below are ONLY covered if the procedure is performed according to the "Policy" section of this document. 

Covered Codes