Is micropunch grafting for vitiligo covered by health insurance?

Since December 1, 2019.

Through a revision of the Ministry of Health and Welfare notice, skin grafting using a micro punch was explicitly included under the "full-thickness skin graft" item in the health insurance system. According to the Health Insurance Review and Assessment Service, criteria were established to recognize medical care benefits for micropunch full-thickness skin grafting performed for vitiligo.

At the same time, autologous epidermal grafting using suction blisters was also codified in the health insurance system as "partial-thickness skin graft."

In the past, there was no clear reimbursement basis for micropunch grafting; the 2019 revision allowed surgical treatment for vitiligo to be more clearly recognized within the health insurance system.

Not necessarily. For health insurance coverage of vitiligo treatment, the location of the lesions must also be considered.

According to the Health Insurance Review and Assessment Service's reimbursement principles for vitiligo treatment, coverage is recognized for treatment of exposed areas that can affect social life, such as the face, neck, hands, arms, and areas below the knees, as well as lesions connected to these areas.

Therefore, simply having a diagnosis of vitiligo does not mean that health insurance will apply equally to treatment of all areas.

Whether health insurance applies and whether the vitiligo is suitable for surgery are separate issues.

Micropunch grafting is generally considered for stable vitiligo where pigment recovery has been insufficient despite phototherapy or medication, and where no new lesions have appeared or existing lesions have not enlarged for a certain period.

In particular, if vitiligo continues to progress after surgery, the transplanted pigment may not remain stable, so it is important to assess disease activity before surgery.

In fact, a study on 0.8 mm micropunch grafting found that vitiligo that had remained stable for 12 months or longer was a factor associated with better treatment outcomes. A comprehensive analysis of multiple vitiligo surgery studies also reported that patient age, vitiligo type, and lesion location may influence treatment results.

Therefore, the decision to undergo surgery should not be based solely on lesion size but should consider the following factors together:

- Whether new vitiligo lesions have appeared recently

- Whether existing lesions are expanding

- How well the lesions have responded to phototherapy or medication

- Which areas are affected, such as the face, neck, or hands

- The type and extent of vitiligo

It may be necessary. Micropunch grafting is not simply a skin transplant that completes treatment; the process by which the transplanted melanocytes spread to the surrounding vitiligo skin and restore pigment is crucial.

For this reason, phototherapy such as excimer laser is often used after surgery to aid pigment recovery. In the 0.8 mm micropunch grafting study, treatment outcomes were evaluated after combining excimer therapy following surgery.

Additionally, for health insurance claims, medical records and surgical records are needed to confirm the treatment area and surgical scope.

Ultimately, what matters in vitiligo surgery is not simply checking whether the surgery is covered by health insurance. To expect more stable pigment recovery, you should also plan whether the vitiligo is stable enough for surgery, which areas will be treated, and what follow-up treatment will be continued after surgery.