Cosmetic procedures are those provided to improve an individual's physical appearance, from which no significant improvement in physiologic function can be expected. Emotional and/or psychological improvement alone does not constitute improvement in physiologic function.
Collagenase clostridium histolyticum is a combination of bacterial collagenases with multiple medical and cosmetic uses. It is marketed under brand names Xiaflex and Qwo, each of which serve distinct populations. Intended uses for Xiaflex include Peyronie's disease and Dupuytren's contracture; medical necessity criteria is detailed in a separate policy. Qwo is a prescription medication used to treat moderate to severe buttocks cellulite in adult women via subcutaneous injection. Specifically, Qwo enzymatically targets the fibrous connective tissue tethering the skin to the underlying fascia; disruption of these fibrous septae diminish the "dimpling" effect and lead to improved cellulite appearance. Although Qwo is the same pharmaceutical substance as Xiaflex, it is not indicated for treatment of Peyronie's disease or Dupuytren's contracture; it is approved solely for cosmetic usage.