Destructive procedures are the standard of care for treatment of actinic keratoses

Background: Actinic keratoses are premalignant lesions resulting from expos ure to carcinogens. Recently, some Medicare carriers have limited reimburse ment for destruction of actinic keratoses to those lesions unresponsive to topical 5-fluorouracil treatment. Objective: Our purpose was to determine whether this policy meets the commu nity standard of care for treatment of actinic keratoses. Methods: Data from the 1993 and 1994 National Ambulatory Medical Care Surve y were used to determine the frequencies at which different treatments are used for actinic keratoses. These were compared with the frequencies at whi ch procedures and medical therapies are used to treat control conditions (w arts, psoriasis, acne, and dermatitis) to determine whether procedures are done because they are available or out of medical necessity. Results: Procedures were performed during 78% of visits for actinic keratos es. 5-Fluorouracil was used at 3.6% of visits, and at 39% of these visits a procedure was also performed. There were no observations of use of 5-fluor ouracil alone at a first visit for actinic keratosis. Procedures were less likely to be performed at visits for warts, psoriasis, acne, or dermatitis, which indicates that reimbursable procedures are performed not simply beca use they are available. Conclusion: Procedures are, performed to destroy actinic keratoses out of m edical need. Medicare policies mandating initial use of 5-fluorouracil as i nitial treatment of actinic keratoses do not represent the community standa rd of care for treatment of these lesions.