Appeal type: Experimental/Investigational
Decision: Overturned

Diagnosis: Burn.
Treatment: Laser therapy (0479T x 1 and 0480T x 1).
The insurer denied coverage for laser therapy (0479T x 1 and 0480T x 1).
The denial is overturned.

The patient is a female with an injury. The mechanism of injury was hot contact burns to the palmer surface of the fingers of her right hand that had required split thickness skin grafting and now is having decreased range of motion of the fingers due to hypertrophic scarring. The requesting provider has requested authorization for: Laser treatment to the hypertrophic burn scars on her hand that are limiting range of motion.

The requested service is likely to be more beneficial than any of the standard treatments/procedures for this patient. This has been a tried-and-true treatment for hypertrophic burn scars for nearly the better of two decades. Therefore, the request for laser burn scar revision/treatment is recommended for approval. 

Laser therapy (0479T x 1 and 0480T x 1), has final approval from the appropriate regulatory bodies for this diagnosis. This patient a good candidate for laser therapy (0479T x 1 and 0480T x 1), service. This is the best available treatment for this patient at this time. This has been an accepted treatment for many years. 

Adverse risks are not increased over standard treatment/services. 

"Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Although skin is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse signaling pathways are activated. Stem cells can be activated, allowing increased tissue repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns. LLLT can reduce UV (ultraviolet) damage both as a treatment and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting autoimmunity.  Inflammatory diseases such as psoriasis and acne can also be managed. The noninvasive nature and almost complete absence of side effects encourage further testing in dermatology." (Avci, P. et al. 2013). 

"Conclusions: Fractional ablative laser treatment provides significant, sustained improvement of elasticity, thickness, appearance, and symptoms of mature hypertrophic burn scars." (Miletta, N. et al. 2021). 

"Conclusion: Laser therapy is effective for the treatment of burn scar appearance, including measures such as pigmentation, vascularity, pliability, and thickness. Ablative fractional laser therapy, in particular, shows significant potential for the release of contractures allowing for improved range of motion of affected joints. Patients may benefit from the use of lasers in the treatment of burn scars, and the safety profile of lasers allows the benefits of treatment to outweigh the risks. Laser therapy should be included in burn scar treatment protocols as an adjuvant therapy to traditional interventions." (Willows, B. M. et al. 2017). 

The carrier's denial of laser therapy (0479T x 1 and 0480T x 1) should be overturned.