BlueCross BlueShield of Tennessee Medical Policy Manual

Dermatology

• Bioengineered Skin and Soft Tissue Substitutes

• Browplasty

• Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds

• Extracorporeal Shock Wave Therapy for Wounds

• Facelift, Facial Thread Lift

• Hair Removal

• Hair Transplantation

• Hand and/or Face Transplantation (Composite Tissue Allotransplantation)

• Human Amniotic Membrane Grafts and Amniotic Fluid Injections

• Laser Therapy for Onychomycosis and Active Acne

• Lipectomy and Liposuction for Lymphedema

• Liposuction

• Liposuction and Lipectomy for Lipedema

• Lymphatic Physiologic Microsurgery for Breast Cancer-Related Lymphedema

• Mastectomy for Gynecomastia

• Mentoplasty (Chin Augmentation, Genioplasty)

• Negative Pressure Wound Therapy in the Outpatient Setting

• Non-Contact Ultrasound Treatment for Wounds

• Otoplasty and External Ear Reconstruction

• Pneumatic Compression Pumps

• Rhinoplasty

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