The latest refusal by health insurances to pay for CO2 laser wart removal according to TarMed is a tariff problem that affects all doctors in Switzerland who use CO2 lasers for medical purposes. The SGDV (with a simultaneous mandate from the SGML and the SALC) has already exhausted all its legal possibilities during the last revision of the laser chapter of the TarMed. We absolutely wanted to keep the list of indications below, but were unsuccessful and provided with the following information:
“The Federal Supreme Court ruled in 2003 (BGE 129 V 167) regarding the “Krankenpflege-Leistungsverordnung (KLV, Ordinance on treatments covered by health insurance)” is neither a positive nor a negative list. Appendix 1 of the KLV contains only those types of treatments that have been reviewed by the Commission that are covered by health insurance, not covered by insurance or only covered in certain cases. In the case of treatments that have not been the subject to a review, the presumption that the medical treatment must comply with the principles of scientifically proven efficacy, efficiency and suitability, and thus must be covered by the compulsory health insurance, is valid.
In Appendix 1 KLV, four indications of dermatological laser therapy are listed, two are covered by insurance (nevus teleangiectaticus, condylomata acuminata) and two are not covered by insurance (acne scars, keloid). On April 20, 2012, the FOPH confirmed that the Commission had never dealt with the other indications (such as CO2 laser treatment of actinic precancerous lesions), thus assuming that the WZW criteria are met. It is understood, of course, that the cases must be a medical treatment, and not a treatment with a cosmetic objective.
Accordingly, all dermatological laser therapies not explicitly mentioned in the CLV – such as e.g. Hemangioma, primary (also spider veins) and secondary telangiectasias, venous lake, angiofibroma / angiokeratoms, pyogenic granuloma, Osler’s disease, Ota’s disease, dirt tattoos, tattoo radiotherapy, erythroplasia Queyrat / Bowen, actinic cheilitis, precancerous lesions, skin adnexal tumors: syringomas, adenoma sebaceum, Therapy-resistant warts, condylomata acuminata, nail matrix excision / nail matrix destruction – are to be reimbursed by the cost carrier. “