Keloids are raised, firm growths that extend beyond the original wound boundaries. They can cause cosmetic distress, as well as symptoms like itching, tenderness, and sometimes restricted movement. Intralesional corticosteroid injection (ILI) is considered the first-line and most common non-surgical approach to flattening these scars. Understanding the financial implications of this treatment, particularly the cost of a single injection and the total expense of a full treatment course, is necessary for those considering therapy.
What Intralesional Corticosteroid Injections Do
The injection procedure involves a quick, targeted delivery of medication directly into the dense, fibrous tissue of the keloid. The corticosteroid most frequently used is Triamcinolone Acetonide (TAC), which is a potent anti-inflammatory and anti-proliferative agent. TAC suppresses the inflammation that fuels scar growth and inhibits the activity of fibroblasts, which are the cells responsible for producing excess collagen.
The medication also promotes the breakdown of existing scar tissue by increasing the local production of collagenase, an enzyme that degrades collagen. By inducing vasoconstriction, or the narrowing of blood vessels, TAC reduces the blood supply to the keloid, diminishing the growth factors and nutrients that sustain the scar. The injection is administered directly into the lesion, ensuring high concentrations of the drug reach the target tissue with minimal systemic exposure.
The Estimated Cost of a Single Injection Session
The out-of-pocket cost for a single intralesional corticosteroid injection session for a keloid typically falls within a range of $100 to $300. This price represents the fee for the service, combining the provider’s administration fee and the cost of the drug. The injectable corticosteroid is a relatively inexpensive generic drug, meaning the bulk of the cost is usually related to the medical procedure and overhead.
Costs can vary significantly depending on the clinical setting where the injection is performed. A session at a community clinic or a primary care physician’s office may be closer to the lower end of the spectrum. Conversely, receiving the injection from a specialized, board-certified dermatologist or plastic surgeon in a high-cost metropolitan area often results in prices approaching or exceeding the $300 mark. For billing purposes, the procedure is generally itemized using CPT code 11900 for up to seven lesions, or CPT code 11901 if more than seven lesions are treated in the session.
Variables That Determine the Total Treatment Price
The total price of keloid treatment is multiplicative and depends on several patient-specific variables. Keloid treatment is rarely a one-time event, typically requiring a series of injections to achieve significant flattening and symptom relief. Most treatment protocols involve multiple sessions, often ranging from three to eight injections spaced approximately four to eight weeks apart. This frequency means that a single session’s fee must be multiplied by the total number of visits required over several months.
The size and overall number of keloids also directly influence the cost per session. Larger keloids or those with a greater volume of scar tissue require a higher volume of the corticosteroid, which can increase the medication component of the bill. Furthermore, a patient with multiple keloids will trigger the use of the higher-level CPT code (11901), impacting the per-session charge. The expertise of the medical professional is another factor; specialists like dermatologists or plastic surgeons may charge more for their specialized knowledge compared to a general practitioner.
Navigating Insurance Coverage and Patient Responsibility
Navigating insurance coverage for keloid treatment can be complex, as the difference between a medical necessity and a cosmetic procedure dictates coverage. Treatment is generally covered when the keloid causes pain, itching, or restricts movement around a joint. If the treatment is sought purely for aesthetic improvement without accompanying physical symptoms, the insurance company is likely to classify it as cosmetic and deny coverage.
Patients are responsible for understanding their health plan’s specific policies and confirming whether the CPT codes 11900 or 11901 are covered under their benefits. Even with coverage, the patient will still be financially responsible for standard out-of-pocket costs such as co-pays, co-insurance, and meeting their annual deductible. It is advisable to contact the insurance provider prior to beginning a multi-session treatment plan to obtain a pre-authorization and a clear estimate of the expected patient responsibility.