Revisions From 12.01.03b:
02/21/2024 | This policy has been reviewed and reissued in accordance with the Company's continuing position on Cosmetic Procedures. |
07/01/2023 | This version of the policy will become effective 07/01/2023.
This policy has been updated to communicate that the Company’s coverage position for injectable dermal fillers (e.g., Sculptra, Radiesse) has changed from Potentially Cosmetic to Always Cosmetic. Therefore, they are not eligible for reimbursement consideration. |
Revisions From 12.01.03a:
11/16/2022 | This policy has been reviewed and reissued in accordance with the Company's continuing position on Cosmetic Procedures. |
06/16/2021
| This policy has been reissued in accordance with the Company's annual review process.
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11/23/2020
| This version of the policy will become effective 11/23/2020. The policy has been updated to communicate that the prescription brand drug Qwo (collagenase clostridium histolyticum) is not covered by the Company because it is considered a cosmetic service. Services that are cosmetic are a benefit contract exclusion for all products of the Company and are not eligible for reimbursement consideration.
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Revisions From 12.01.03:
05/22/2019 | This policy has been reviewed and reissued in accordance with the Company's continuing position on Cosmetic Procedures. |
10/24/2018 | This policy has been reissued in accordance with the Company's annual review process. |
Effective 10/05/2017 this policy has been updated to the new policy template format.