Non-Pharmacologic Treatment of Rosacea

POLICY NUMBER

A.2.01.71

DESCRIPTION

Rosacea is a chronic, inflammatory skin condition without a known cure; the goal of treatment is symptom management. Non-pharmacologic treatments, including laser and light therapy as well as dermabrasion, are proposed for patients who do not want to use or are unresponsive to pharmacologic therapy.

Rosacea

Rosacea is characterized by episodic erythema, edema, papules, pustules, and telangiectasia that occur primarily on the face but also present on the scalp, ears, neck, chest, and back. On occasion, rosacea may affect the eyes. Patients with rosacea tend to flush or blush easily. Because rosacea causes facial swelling and redness, it is easily confused with other skin conditions, such as acne, skin allergy, and sunburn.

Rosacea mostly affects adults with fair skin between the ages of 20 and 60 years and is more common in women, but often is most severe in men. Rosacea is not life-threatening, but if not treated, it may lead to persistent erythema, telangiectasias, and rhinophyma (hyperplasia and nodular swelling and congestion of the skin of the nose). The etiology and pathogenesis of rosacea are unknown, but may result from both genetic and environmental factors. Some theories on the causes of rosacea include blood vessel disorders, chronic Helicobacter pylori infection, Demodex folliculorum (mites), and immune system disorders.

While the clinical manifestations of rosacea do not usually impact the physical health status of the patient, psychological consequences from the most visually apparent symptoms (ie, erythema, papules, pustules, telangiectasias) may impact the quality of life. Rhinophyma, an end-stage of chronic acne, has been associated with obstruction of nasal passages and basal cell carcinoma in rare, severe cases. The probability of developing nasal obstruction or basal or squamous cell carcinoma with rosacea is not sufficient to warrant preventive removal of rhinophymatous tissue.

Treatment

Rosacea treatment can be effective in relieving signs and symptoms. Treatment may include oral and topical antibiotics, isotretinoin, β-blockers, alpha₂-adrenergic agonists (e.g., oxymetazoline, clonidine), and anti-inflammatories. Patients are also instructed on various self-care measures such as avoiding skin irritants and dietary items thought to exacerbate acute flare-ups.

Non-pharmacologic therapy has also been tried in patients who cannot tolerate or do not want to use pharmacologic treatments. To reduce visible blood vessels, treat rhinophyma, reduce redness, and improve appearance, various techniques have been used such as laser and light therapy, dermabrasion, chemical peels, surgical debulking, and electrosurgery. Various lasers used include low-powered electrical devices and vascular light lasers to remove telangiectasias, carbon dioxide lasers to remove unwanted tissue from rhinophyma and reshape the nose, and intense pulsed lights that generate multiple wavelengths to treat a broader spectrum of tissue.

Several laser and light therapy systems have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process for various dermatologic indications, including rosacea. For example, rosacea is among the indications for:

• Vbeam laser system (Candela)

• Stellar M22™ laser system (Lumenis)

• excel VT®, excel V®, and xeo® laser systems (Cutera)

• Harmony® XL multi-application platform laser device (Alma Lasers, Israel)

• UV-300 Pulsed Light Therapy System (New Star Lasers)

• CoolTouch® PRIMA Pulsed Light Therapy System (New Star Lasers).

POLICY

Non-pharmacologic treatment of rosacea, including but not limited to laser and light therapy, dermabrasion, chemical peels, surgical debulking, and electrosurgery, is considered investigational.

POLICY EXCEPTIONS

Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.

POLICY GUIDELINES

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

Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.

POLICY HISTORY

05/18/2006: Approved by Medical Policy Advisory Committee (MPAC)

1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions.

5/1/2008: Policy reviewed, no changes

04/22/2010: Policy description updated regarding FDA status of devices. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.

02/23/2011: Policy reviewed; no changes.

01/19/2012: Policy reviewed; no changes.

04/01/2013: Policy reviewed; no changes.

03/07/2014: Policy reviewed; no changes.

01/20/2015: Policy description updated regarding rhinophyma. Policy statement unchanged.

08/28/2015: Code Reference section updated for ICD-10.

01/12/2016: Policy reviewed; no changes. Investigative definition updated in policy guidelines section.

06/01/2016: Policy number A.2.01.71 added.

01/13/2017: Policy description updated regarding devices. Policy statement unchanged.

01/15/2018: Policy description updated. Policy statement unchanged.

01/11/2019: Policy reviewed; no changes.

01/15/2020: Policy reviewed; no changes.

02/01/2021: Policy description updated regarding devices. Policy statement unchanged.

02/02/2022: Policy description updated regarding rosacea and treatment. Policy statement unchanged.

12/29/2022: Policy reviewed; no changes.

01/24/2023: Policy reviewed; no changes.

12/08/2023: Policy reviewed; no changes.

01/08/2024: Policy reviewed; no changes.

02/05/2025: Policy reviewed; no changes.

SOURCE(S)

Blue Cross Blue Shield Association policy # 2.01.71

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

Investigational Codes

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