19 Jan Acne Surgery Vs. SilkPeels Vs. Facials
To our valued clients at RefinedMD: There has been some confusion regarding what treatments for acne are covered by insurance and what treatments are considered to be cosmetic in nature.
Acne is a specific condition of the skin and is considered a disorder of the pilosebaceous units where there is a medical indication for both topical and systemic treatment of the condition. In more advanced cases, the elimination of large comedones can remove the precursors of inflammatory acne and speed the recovery process. This treatment usually entails steam to soften the surface layer of the skin and then extraction of those blackheads and whiteheads using a comedone extractor. In order to bill your insurance for such a treatment, we need to maintain an ongoing diagnosis of acne. This treatment does not include SilkPeel treatments nor any treatment considered to be a ‘facial’. Insurance only pays for mechanical extraction and refers to this as ‘acne surgery’. These extractions can be performed by a physician, a nurse practitioner, physician assistant, RN or an esthetician under the supervision of the doctor. In order to bill your insurance for such treatments, there needs to an underlying diagnosis of documentable acne. Insurance will not cover a facial treatment or SilkPeel because it ‘keeps the acne from coming back’.
The guidelines for acne surgery for RefinedMD are as follows:
- Documented acne of any grade under regular supervision by an MD, NP, or PA where it is determined that acne extractions will be of benefit may be covered by your insurance. A bi-monthly visit with your licensed provider will be necessary in order to maintain that diagnosis if appropriate. We must also document that you are using prescription medications on a regular basis. Tretinoin (Retin–A) is an essential part of treating comedonal acne and must be part of your skin care regimen.
- Tretinoin may be covered by insurance for teenage comedonal acne but often is not for adults over 25. If it is not covered by your insurance, we have an excellent selection of Retin A products for sale in the office.
- Acne extractions if appropriate are the only part of your visit that is covered by insurance. For those of you interested, the actual insurance CPT code is referred to as ‘acne surgery’. If pre or post-treatment with the SilkPeel System is of benefit or is preferred by you, this is not covered and will be billed to you separately.
- Small comedones on the nose and central face in adults are components of normal mature skin and do not consider to be acne. We all have oil glands on our nose and face where with enough suction, we can always pull out those small columns of sebum. This is not acne surgery.
We take great pride in our investment of the newest and most sophisticated SilkPeel and Dermalinfusion Systems and highly recommend regular treatments as part of the maintenance of optimal skin at any age. SilkPeels and other Facial Treatments are available as ‘add-ons’ to an acne visit or as single treatments or packages for those who are interested in experiencing this advanced technology for skin care.
If you have any questions, please give us a call.
Dr. Steven Swengel MD and the rest of the Refined staff