Medical Policy
Policy Num: 02.001.070
Policy Name: Laser Treatment for Onychomycosis
Policy ID: [2.001.070] [Ac / B / M- / P-] [2.01.89]
Last Review: January 22, 2024
Next Review: January 20, 2025
Related Policies:
02.001.010 - Nonpharmacologic Treatment of Rosacea
Population Reference No. |
Populations |
Interventions |
Comparators |
Outcomes |
1 |
Individuals: · With onychomycosis |
Interventions of interest are: · Laser therapy |
Comparators of interest are:
|
Relevant outcomes include:
|
Onychomycosis is a common fungal infection of the nail. Currently available treatments for onychomycosis, including systemic and topical antifungal medications, have relatively low efficacy and require a long course of treatment. Laser systems are proposed as another treatment option.
For individuals who have onychomycosis who receive treatment with laser therapy, the evidence includes small, randomized controlled trials. Relevant outcomes are symptoms, change in disease status, medication use, and treatment-related morbidity. The randomized controlled trials reported inconsistent results and had methodologic limitations. Clinical and mycologic outcomes differed across the trials, lacked consistent blinding of outcome assessments, and often reported outcomes on a per-nail basis without accounting for correlated measurements. The published evidence to date does not permit determining whether laser treatment improves health outcomes in patients with onychomycosis. Additionally, some registered clinical trials are completed without publication of results, indicating potential publication bias. Additional well-designed, adequately powered, and well-conducted randomized controlled trials are needed. The evidence is insufficient to determine that the technology results in an improvement in the net health outcomes.
Not applicable.
The objective of this evidence review is to evaluate whether the use of laser therapy improves net health outcomes in individuals with onychomycosis compared with topical and oral medications alone.
Laser treatment of onychomycosis is considered investigational.
Please see the Codes table for details.
Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. Benefit products or negotiated coverages may have all or some of the services discussed in this medical policy excluded from their coverage.
State or federal mandates (eg, Federal Employee Program) may dictate that certain U.S. Food and Drug Administration approved devices, drugs, or biologics may not be considered investigational, and thus these devices may be assessed only by their medical necessity.
The approach to laser treatment of onychomycosis will depend on benefit language related to definitions of medically necessary, reconstructive, and cosmetic services. Procedures are considered reconstructive when intended to address a significant variation from normal related to accidental injury, disease, trauma, treatment of a disease, or congenital defect. Not all benefit contracts include benefits for reconstructive services. Benefit language supersedes this document.
Onychomycosis is a common chronic fungal infection of the nail. It is estimated to cause up to 50% of all nail diseases and 33% of cutaneous fungal infections.1, The condition can affect toenails or fingernails but is more frequently found in toenails. Primary infectious agents include dermatophytes (eg, Trichophyton species), yeasts (eg, Candida albicans), and nondermatophytic molds. In temperate Western countries, infections are generally caused by dermatophytes.
Aging is the most common risk factor for onychomycosis, most likely due to decreased blood circulation, longer exposure to fungi, and slower nail growth. Also, various medical conditions increase the risk of comorbid onychomycosis. They include diabetes, obesity, peripheral vascular disease, immunosuppression, and HIV infection. In certain populations, onychomycosis may lead to additional health problems. Although there is limited evidence of a causal link between onychomycosis and diabetic foot ulcers, at least 1 prospective study with diabetic patients found onychomycosis to be an independent predictor of foot ulcers.2, Moreover, onychomycosis, especially more severe cases, may adversely impact the quality of life. Patients with onychomycosis have reported pain, uncomfortable nail pressure, embarrassment, and discomfort wearing shoes.3,4,
The diagnosis of onychomycosis can be confirmed by potassium hydroxide preparation, culture, or histology.
Treatments for onychomycosis include topical antifungals such as nail paints containing ciclopirox (ciclopiroxolamine), efinaconazole, tavaborole, or amorolfine (not available in the US), and oral antifungals such as terbinafine and itraconazole. These have low-to-moderate efficacy and a high relapse rate. Topical antifungals and some long-available oral medications (eg, griseofulvin) require a long course of treatment, which presents issues for patient compliance. Moreover, oral antifungal medications have been associated with adverse effects such as a risk of hepatotoxicity.
Several types of device-based therapies are under investigation for the treatment of onychomycosis, including ultrasound, iontophoresis, photodynamic therapy, and laser systems. A potential advantage of lasers is that they have greater tissue penetration than antifungal medication and thus may be more effective at treating infection embedded within the nail. Another potential advantage is that laser treatments are provided in a clinical setting in only 1 or several sessions and, thus, require less long-term patient compliance.
Laser treatment of onychomycosis uses the principle of selective photothermolysis, defined as the precise targeting of tissue using a specific wavelength of light. The premise is that light is absorbed into the target area and heat generated by that energy is sufficient to damage the target area while sparing the surrounding area. The aim of laser treatment for onychomycosis is to heat the nail bed to temperatures required to disrupt fungal growth (approximately 40°to 60°C) and at the same time avoid pain and necrosis to surrounding tissues.5,
Characteristics of laser systems used to treat onychomycosis are listed in Table 1.5,
Variables | Characteristics |
Wavelength | Lasers are single-wavelength light sources. There needs to be sufficient tissue penetration to adequately treat nail fungus. The near-infrared spectrum tends to be used because this part of the spectrum has maximum tissue penetrance in the dermis and epidermis and the nail plate is similar to the epidermis. To date, most laser systems for treating onychomycosis have been Neodymium yttrium aluminum garnet (Nd:YAG) lasers that typically operate at 1064 nm; 940- to 1320-nm and 1440-nm wavelengths are also options. |
Pulse duration | Pulses need to be short to avoid damaging the tissue surrounding the target area. For example, short-pulse systems have microsecond pulse durations and Q-switched lasers have nanosecond pulse durations. |
Repetition rate (frequency of pulses, in hertz) | Spot size to the diameter of the laser beam. For treating onychomycosis, laser spot sizes range from 1 to 10 nm. |
Fluence (in J/cm2) | Fluence refers to the amount of energy delivered into the area |
Multiple Nd:YAG laser systems have been cleared by the U.S. Food and Drug Administration (FDA) for marketing for the temporary increase of clear nail in patients with onychomycosis. The FDA has determined that these devices were substantially equivalent to existing devices. Table 2 lists select approved laser systems.
Device | Manufacturer | Approved |
Nd:YAG 1064-nm laser systems | ||
PinPointe™ FootLaser™ | PinPointe USA (acquired by NuvoLase 2011) | 2010 |
GenesisPlus™ | Cutera | 2011 |
JOULE ClearSense™ | Sciton | 2011 |
GentleMax Family of Laser Systems | Candela | 2014 |
Nordlys | Ellipse A/S | 2016 |
Dual-wavelength Nd:YAG 1064-nm and 532-nm laser system | ||
Q-Clear™ | Light Age | 2011 |
Nd:YAG 1064-nm laser systems (FDA product code: GEX); dual-wavelength Nd:YAG 1064-nm and 532-nm laser system (FDA product code: PDX).
This evidence review was created in May 2013 and has been updated regularly with searches of the PubMed database. The most recent literature update was performed through October 18, 2023.
Evidence reviews assess the clinical evidence to determine whether the use of technology improves the net health outcome. Broadly defined, health outcomes are the length of life, quality of life, and ability to function, including benefits and harms. Every clinical condition has specific outcomes that are important to patients and managing the course of that condition. Validated outcome measures are necessary to ascertain whether a condition improves or worsens; and whether the magnitude of that change is clinically significant. The net health outcome is a balance of benefits and harms.
To assess whether the evidence is sufficient to draw conclusions about the net health outcome of technology, 2 domains are examined: the relevance, and quality and credibility. To be relevant, studies must represent one or more intended clinical use of the technology in the intended population and compare an effective and appropriate alternative at a comparable intensity. For some conditions, the alternative will be supportive care or surveillance. The quality and credibility of the evidence depend on study design and conduct, minimizing bias and confounding that can generate incorrect findings. The randomized controlled trial (RCT) is preferred to assess efficacy; however, in some circumstances, nonrandomized studies may be adequate. Randomized controlled trials are rarely large enough or long enough to capture less common adverse events and long-term effects. Other types of studies can be used for these purposes and to assess generalizability to broader clinical populations and settings of clinical practice.
Promotion of greater diversity and inclusion in clinical research of historically marginalized groups (e.g., People of Color [African-American, Asian, Black, Latino and Native American]; LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual); Women; and People with Disabilities [Physical and Invisible]) allows policy populations to be more reflective of and findings more applicable to our diverse members. While we also strive to use inclusive language related to these groups in our policies, use of gender-specific nouns (e.g., women, men, sisters, etc.) will continue when reflective of language used in publications describing study populations.
Population Reference No. 1
The purpose of laser treatment in patients who have onychomycosis is to provide a treatment option that is an alternative to or an improvement on existing therapies.
The question addressed in this evidence review is: Does the use of laser treatment improve the net health outcome compared with topical antifungal nail lacquer or oral antifungal therapy in patients who have onychomycosis?
The following PICO was used to select literature to inform this review.
The relevant population of interest is patients with onychomycosis.
The therapy being considered is laser treatment. Laser treatment allows for precise targeting of the fungal areas with enough heat to disrupt growth while avoiding damage to surrounding tissues. Two types of lasers have been developed to treat onychomycosis: neodymium-doped:yttrium aluminum garnet (Nd:YAG) and diode lasers.
Current treatments for onychomycosis include topical antifungal nail lacquer and oral antifungal therapy. These treatments typically require long courses, which result in poor patient compliance and high relapse rates. Nail lacquers contain ciclopirox or amorolfine. Oral medications are terbinafine and itraconazole, which have been associated with a risk of hepatotoxicity.
The general outcomes of interest are symptom relief (eg, clear nail growth), change in disease status (eg, mycologic remission or Onychomycosis Severity Scale scores), reduction in medication use, and treatment-related morbidity.
Clinical response can be measured after laser treatment (3-6 months). To determine remission rates, follow-up may last a year or more.
To assess efficacy outcomes, comparative controlled prospective trials were sought, with a preference for RCTs.
A systematic review by Bristow et al (2014) identified 12 published studies on laser treatment for onychomycosis in a literature search conducted in June 2014.6, Two were RCTs, 4 were nonrandomized comparative studies with no placebo or control group, and 6 were case series. Bristow et al (2014) did not pool study findings, concluding the evidence was limited and of poor methodologic quality.
Representative RCTs published after the systematic review, with the largest sample sizes, and comparing laser treatment with placebo or a different intervention are described next and in Tables 3 through 6.
Eight representative RCTs published after the systematic review compared laser treatment with placebo or a different intervention.7,8,9,10,11,12,13,14, These RCTs have generally compared laser therapy with either systemic or topical therapy, and often a combination laser and systemic/topical regimen. The primary outcomes evaluated in these trials have varied and generally were not uniformly or explicitly defined. Many trials report on clinical or mycological cure or improvement, the results of which have been conflicting. Moreover, follow-up duration has varied, ranging from 12 weeks in Kim et al to 12 months in Karsai et al and Nijenhuis-Rosien et al (LASER-1: Laser Therapy for Onychomycosis in Patients With Diabetes at Risk for Diabetic Foot Complications).10,12,11, Various methodologic limitations are also present. For example, Sabbah et al (2019) did not recruit the prespecified sample required to be adequately powered, and reported outcomes only for the most severely affected greater toenail, which may not be representative of less severely affected nails.13, Additionally, Xu et al (2014) reported outcomes on a per-nail basis, which did not account for correlated measurements.14, All trials employed laser therapy with 1064-nm Nd:YAG laser therapy.
Study; Trial | Countries | Sites | Dates | Participants | Interventions | |
Active | Comparator | |||||
Nasif et al (2023)15, | Egypt | 1 | NR | 40 adults with onychomycosis | Laser therapy (6 sessions) | Itraconazole pulse therapy only (200 mg twice daily for 1 week per month over 3 months) |
Hamed Khater et al (2020)9, | Egypt | 1 | NR | 30 adults with onychomycosis | Laser therapy (every 2 weeks for 3 months) + itraconazole pulse therapy (200 mg twice daily for 1 week per month over 3 months) | Itraconazole pulse therapy only |
Bunyaratavej et al (2020 )7, | Thailand | 1 | 2015-2019 | 60 adults with mycologically proven onychomycosis | Laser therapy only (4 sessions at 1-month intervals) Laser therapy + topical amorolfine |
Topical amorolfine only |
Nijenhuis-Rosien et al (2019); LASER-112, | Netherlands | 1 | 2015-2016 | 63 adults at risk for diabetic foot ulcer and with suspected onychomycosis | Laser therapy (4 sessions) | Sham laser therapy |
Sabbah et al (2019)13, | Canada | 1 | 2013-2014 | 51 adults with mycologically confirmed onychomycosis involving at least 25% of 1 great toenail | Laser therapy (3 sessions) | Sham laser therapy |
Karsai et al (2017)10, | Germany | 1 | 2013-2015 | 20 adults with mycologically proven onychomycosis | Laser therapy (4 treatments at 4- to 6-week intervals) | No laser therapy |
Kim et al (2016)11, | Korea | 1 | 2014-2015 | 56 patients with mycologically proven onychomycosis | Laser therapy only (3 sessions at 4-week intervals; 4th session permitted if <50% clinical response) Laser therapy + topical naftifine |
Topical naftifine only |
El-Tatawy et al (2015)8, | Egypt | 1 | NR | 40 adult females with onychomycosis | Laser therapy (4 sessions at 1-week intervals) | Topical terbinafine |
Xu et al (2014)14, | China | 1 | 2011-2012 | 53 adults with onychomycosis | Laser therapy only (once weekly) Laser + oral terbinafine |
Oral terbinafine only |
RCT: randomized controlled trial; NR: not reported.
Study; Trial | Onychomycosis Severity Index | Clinical response | Mycological cure | Improvement | Clearance |
Nasif et al (2023)15, | N=40 | N=40 | N=40 | ||
Laser therapy only | Reduction %, median (IQR) = 100 (90 to 100) | No: 0 Mild: 0 Moderate: 1 Marked: 19 |
Negative: 19 Positive: 1 |
||
Itraconazole pulse therapy alone | Reduction %, median (IQR) = 100 (90 to 100) |
No: 0 Mild: 0 Moderate: 5 Marked: 15 |
Negative: 15 Positive: 5 |
||
p-value | .721 | .181 | |||
Hamed Khater et al (2020)9, | N=30 | ||||
Laser therapy + itraconazole pulse therapy | Clinical improvement at 6 to 9 months: Mild: 1/15 (6.7%) Moderate: 1/15 (6.7%) Good: 3/15 (19.9%) Mycological improvement at 6 to 9 months: Mild: 5/15 (33.3%) Moderate: 6/15 (40%) Excellent: 10/15 (66.7%) |
||||
Itraconazole pulse therapy alone | Clinical improvement at 6 to 9 months: Mild: 2/15 (13.3%) Moderate: 5/15 (33.3%) Good: 6/15 (40%) Mycological improvement at 6 to 9 months: Mild: 5/15 (33.3%) Moderate: 6/15 (40%) Excellent: 2/15 (13.3%) |
||||
p-value | Clinical improvement:.001 Mycological improvement: NS |
||||
Bunyaratavej et al (2020 )7, | N=60 | ||||
Laser therapy only | 7/20 (35%) at mean 5.9 months | ||||
Laser therapy + topical amorolfine | 12/20 (60%) at mean 5.2 months | ||||
Topical amorolfine only | 13/20 (65%) at mean 4.8 months | ||||
p-value | p=.05 for combination therapy vs. laser therapy alone; p=NS for combination therapy vs. topical amorolfine | ||||
Nijenhuis-Rosien et al (2019); LASER-112, | N=63 | ||||
Laser therapy | 52 weeks: 14/32 (43.8%) | ||||
Sham laser therapy | 52 weeks: 13/31 (41.9%) | ||||
p-value | 1.00 | ||||
Sabbah et al (2019)13, | N=51 | ||||
Laser therapy | 52 weeks: 0/25 | ||||
Sham laser therapy | 52 weeks: 2/26 (7.7%) | ||||
p-value | .49 | ||||
Karsai et al (2017)10, | N=20 | N=20 | |||
Laser therapy | 52 weeks: 2.0-point increase | 52 weeks: 0/20 | |||
No laser therapy | 52 weeks: 3.6-point increase | 52 weeks: 0/20 | |||
Difference (95% CI); p-value | -1.6 (-0.7 to +3.9); p=.5531 | ||||
Kim et al (2016)11, | N=56 | N=56 | |||
Laser therapy alone | 12 weeks: 70.9% 24 weeks: 76.0% |
12 weeks: 8.9% 24 weeks: 15.2% |
|||
Laser + topical antifungal therapy | 12 weeks: 73.2% 24 weeks: 71.8% |
12 weeks: 14.1% 24 weeks: 22.5% |
|||
Topical therapy alone | 12 weeks: 14.9% 24 weeks: 20.9% |
12 weeks: 6.0% 24 weeks: 4.5% |
|||
p-value | p<.05 for both groups vs. topical therapy alone | p<.05 for both groups vs. topical therapy alone | |||
El-Tatawy et al (2015)8, | N=40 | ||||
1064-nm Nd:YAG laser | 6 months: Marked: 20/20 (100%) |
||||
Topical terbinafine | 6 months: Marked: 0 Moderate: 2/20 (10%) Mild: 8/20 (40%) None: 10/20 (50%) |
||||
p-value | .002 | ||||
Xu et al (2014)14, | N=54 | ||||
Laser therapy | 24 weeks: 20 (64.5%) of 31 nails1 | ||||
Topical terbinafine | 24 weeks: 22 (73.3%) of 30 nails1 | ||||
Laser therapy + topical terbinafine | 24 weeks: 28 (96.6%) of 29 nails1 | ||||
p-value | p<.05 for both groups vs. combination therapy |
CI: confidence interval; NS: not significant 1≤5% nail plate involvement in onychomycosis
Study; Trial | Populationa | Interventionb | Comparatorc | Outcomesd | Follow-Upe |
Nasif et al (2023)15, | 5. Clinically significant difference not prespecified | ||||
Hamed Khater et al (2020)9, | 5. Clinically significant difference not prespecified | ||||
Bunyaratavej et al (2020 )7, | 1. Topical therapy regimen not described | 2. Patient applied | 5. Clinically significant difference not prespecified | ||
Nijenhuis-Rosien et al (2019); LASER-112, | |||||
Sabbah et al (2019)13, | |||||
Karsai et al (2017)10, | 2. Patient applied | 5. Clinically significant difference not prespecified | |||
Kim et al (2016)11, | 2. Patient applied | 5. Clinically significant difference not prespecified | |||
El-Tatawy et al (2015)8, | 2. Patient applied | 5. Clinically significant difference not prespecified | |||
Xu et al (2014)14, | 5. Clinically significant difference not prespecified |
IQR: interquartile range. The study limitations stated in this table are those notable in the current review; this is not a comprehensive gaps assessment. a Population key: 1. Intended use population unclear; 2. Clinical context is unclear; 3. Study population is unclear; 4. Study population not representative of intended use. b Intervention key: 1. Not clearly defined; 2. Version used unclear; 3. Delivery not similar intensity as comparator; 4.Not the intervention of interest. c Comparator key: 1. Not clearly defined; 2. Not standard or optimal; 3. Delivery not similar intensity as intervention; 4. Not delivered effectively. d Outcomes key: 1. Key health outcomes not addressed; 2. Physiologic measures, not validated surrogates; 3. No CONSORT reporting of harms; 4. Not establish and validated measurements; 5. Clinical significant difference not prespecified; 6. Clinical significant difference not supported. e Follow-Up key: 1. Not sufficient duration for benefit; 2. Not sufficient duration for harms.
Study; Trial | Allocationa | Blindingb | Selective Reportingc | Data Completenessd | Powere | Statisticalf |
Nasif et al (2023)15, | 3. Allocation concealment method not reported | 1. Blinding methods not described | 1. Power calculations not performed | |||
Hamed Khater et al (2020)9, | 3. Allocation concealment method not reported | 1. Blinding methods not described | 1. Power calculations not performed | |||
Bunyaratavej et al (2020 )7, | 3. Allocation concealment method not reported | 1. Blinding methods not described | 1. Power calculations not performed | |||
Nijenhuis-Rosien et al (2019); LASER-112, | ||||||
Sabbah et al (2019)13, | 1. Patients, not clinicians, were blinded | |||||
Karsai et al (2017)10, | 3. Allocation concealment method not reported | 1. Patients, not clinicians, were blinded | 1. Power calculations not performed | |||
Kim et al (2016)11, | 3. Allocation concealment method not reported | 1. Blinding not reported | 1. Power calculations not performed | |||
El-Tatawy et al (2015)8, | 3. Allocation concealment method not reported | 1. Blinding not reported | 1. Power calculations not performed | |||
Xu et al (2014)14, | 3. Allocation concealment method not reported | 1. Blinding not reported | 1. Power calculations not performed |
The study limitations stated in this table are those notable in the current review; this is not a comprehensive gaps assessment. a Allocation key: 1. Participants not randomly allocated; 2. Allocation not concealed; 3. Allocation concealment unclear; 4. Inadequate control for selection bias. b Blinding key: 1. Not blinded to treatment assignment; 2. Not blinded outcome assessment; 3. Outcome assessed by treating physician. c Selective Reporting key: 1. Not registered; 2. Evidence of selective reporting; 3. Evidence of selective publication. d Data Completeness key: 1. High loss to follow-up or missing data; 2. Inadequate handling of missing data; 3. High number of crossovers; 4. Inadequate handling of crossovers; 5. Inappropriate exclusions; 6. Not intent to treat analysis (per protocol for noninferiority trials). e Power key: 1. Power calculations not reported; 2. Power not calculated for primary outcome; 3. Power not based on clinically important difference. f Statistical key: 1. Analysis is not appropriate for outcome type: (a) continuous; (b) binary; (c) time to event; 2. Analysis is not appropriate for multiple observations per patient; 3. Confidence intervals and/or p values not reported; 4. Comparative treatment effects not calculated.
For individuals who have onychomycosis who receive treatment with laser therapy, the evidence includes small, randomized controlled trials. Relevant outcomes are symptoms, change in disease status, medication use, and treatment-related morbidity. The randomized controlled trials reported inconsistent results and had methodologic limitations. Clinical and mycologic outcomes differed across the trials, lacked consistent blinding of outcome assessments, and often reported outcomes on a per-nail basis without accounting for correlated measurements. The published evidence to date does not permit determining whether laser treatment improves health outcomes in patients with onychomycosis. Additionally, some registered clinical trials are completed without publication of results, indicating potential publication bias. Additional well-designed, adequately powered, and well-conducted randomized controlled trials are needed. The evidence is insufficient to determine that the technology results in an improvement in the net health outcomes.
Population Reference No. 1 Policy Statement |
[ ] Medically Necessary | [X] Investigational |
The purpose of the following information is to provide reference material. Inclusion does not imply endorsement or alignment with the evidence review conclusions.
Guidelines or position statements will be considered for inclusion in ‘Supplemental Information’ if they were issued by, or jointly by, a US professional society, an international society with US representation, or National Institute for Health and Care Excellence (NICE). Priority will be given to guidelines that are informed by a systematic review, include strength of evidence ratings, and include a description of management of conflict of interest.
No Practice Guidelines or Position Statements regarding issued by, or jointly by, a US professional society, an international society with US representation, or National Institute for Health and Care Excellence (NICE) were identified.
Not applicable.
There is no national coverage determination. In the absence of a national coverage determination, coverage decisions are left to the discretion of local Medicare carriers.
Some currently ongoing and unpublished trials that might influence this review are listed in Table 7.
NCT No. | Trial Name | Planned Enrollment | Completion Date |
Ongoing | |||
NCT05415852 | Comparison Between Different Types of LASER in the Treatment of Onychomycosis, a Randomized Controlled Trial | 40 | Sept 2022 |
Unpublished | |||
NCT01915355 | Pulsed Dye Laser Treatment of Onychomycosis | 11 | Jul 2015 (completed) |
NCT02019446 | Laser Treatment for Onychomycosis in Diabetesa | 60 | Dec 2021 |
NCT: national clinical trial; Nd:YAG: neodymium yttrium aluminum garnet a Denotes industry-sponsored or cosponsored trial
Codes | Number | Description |
---|---|---|
There is no specific code. See below | ||
CPT | 17999 | Unlisted procedure, skin, mucous membrane and subcutaneous tissue |
96999 | Unlisted special dermatological service or procedure | |
ICD-10-CM | Investigational for relevant diagnoses | |
B35.1 | Dermatophytosis - Tinea unguium (includes onychomycosis) | |
ICD-10-PCS | ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this procedure. | |
Type of Service | Medicine | |
Place of Service | Outpatient |
N/A
Date | Action | Description |
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01/22/2024 | Annual Review | Policy updated with literature review through October 18, 2023; reference added. Policy statement unchanged. |
01/12/2023 | Annual Review | Policy updated with literature review through October 21, 2022; no references added. Policy statement unchanged. |
01/31/2022 | Annual Review | Policy updated with literature review through September 20, 2021; no references added. Policy statement unchanged. |
01/29/2021 | Annual Review | Policy updated with literature review through October 21, 2020; references added. Policy statement unchanged. |
01/22/2020 | Annual Review | Policy updated with literature review through October 14, 2019; no references added. Policy statement unchanged. |
01/30/2019 |
Created |
New policy |