The medical necessity for treatment of port-wine stains

BACKGROUND. Port-wine stains are congenital vascular malformations that can be disfiguring and may lead to psychosocial as well as medical complications. The 585-nm pulsed dye laser is very effective in treating port-wine stains. Laser treatment is often viewed by insurance companies as a ''cosmetic procedure'' and not ''medically necessary.'' Consequently many patients are denied coverage for treatment of their disfiguring birthmarks. OBJECTIVE. TO determine variability of insurance coverage for laser treatment of port-wine stains from state to state. Natural history, progression, and potential complications of pork-wine stains are reviewed and rationale for consistent insurance coverage for laser treatment of port-wine stains is given. METHODS. A questionnaire was mailed to 40 dermatologic surgeons in 22 states and the District of Columbia. We reviewed the literature regarding port-wine stains and their potential complications, and health cave policy guidelines regarding ''medical necessity'' and ''cosmetic procedures.'' RESULTS. Insurance coverage for laser treatment of port-wine stains varies from state to state. CONCLUSION. Based on current health care policy guidelines, laser treatment of port-wine stains should be regarded, and covered, as a medical necessity by all insurance providers. (C) 1997 by the American Society for Dermatologic Surgery, Inc.