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National Coverage Determination (NCD) for Treatment of Actinic Keratosis (250.4)

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Benefit Category
Physician Assistant Services

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

Actinic Keratosis (AKs), also known as solar keratoses, are common, sun-induced skin lesions that are confined to the epidermis and have the potential to become a skin cancer.

Various options exist for treating AKs. Clinicians should select an appropriate treatment based on the patient's medical history, the lesion's characteristics, and on the patient's preference for a specific treatment. Commonly performed treatments for AKs include cryosurgery with liquid nitrogen, topical drug therapy, and curettage. Less commonly performed treatments for AK include dermabrasion, excision, chemical peels, laser therapy, and photodynamic therapy. An alternative approach to treating AKs is to observe the lesions over time and remove them only if they exhibit specific clinical features suggesting possible transformation to invasive squamous cell carcinoma.


Indications and Limitations of Coverage

Medicare covers the destruction of actinic keratoses without restrictions based on lesion or patient characteristics.


Transmittal Number

145

Revision History

10/2001 - Extended coverage for surgical or medical treatment methods, including but not limited to cryosurgery with liquid nitrogen, curettage, excision, and photodynamic therapy, without restrictions based on patient or lesion characteristics. Medicare contractors retain discretion to determine number of visits considered reasonable and necessary to treat these lesions. Effective and implementation dates 11/26/2001. (TN 145) (CR 1892)

09/2012 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 01/07/2013 Effective date: 10/1/2014. (TN 1122) (TN 1122) (CR 7818)


National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

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