CommercialCoverageHigh impact
Phototherapy for Acne (CPB 0656, reviewed 2025-10-03)
Aetna·Dermatology, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Oct 3, 2025
We identified it
Aug 13, 2026
Summary
Aetna has updated CPB 0656 to classify most phototherapy and laser treatments for acne as experimental, investigational, or unproven and therefore non-covered. This includes popular treatments like AviClear Laser, blue light therapy, PDT systems, LED therapy, intense pulsed light, and home-based light devices. Billing teams must immediately deny or obtain prior authorization denials for these procedures and update system rules to prevent claim submissions.
Action Required
Effective immediately (2025-10-03): Billing team must update claim denial rules in billing software to automatically deny or flag for manual review all phototherapy, laser, and light-based acne treatments. Specifically: (1) Configure system to deny CPT codes 96567, 96570, 96571, 96573, 96910-96922 when billed with acne ICD-10 codes (L70.0-L70.9, L73.2); (2) Block billing of CPT 0232T (platelet-rich plasma) and E0200, E0205, E0691-E0694 (heat/UV devices) for acne indications; (3) Block all HCPCS J7308, J7309, J7345 (aminolevulinic acid and methylene blue formulations) for acne; (4) Do not bill for AviClear Laser, ClearLight System, Omnilux Blue, or any home-based light devices for acne treatment; (5) Update provider communication templates and deny letter templates to cite CPB 0656; (6) Train billing and front-desk staff to inform patients these treatments are non-covered. Providers should stop ordering these treatments for acne or expect automatic denials. Failure to implement will result in claim rejections, patient complaints, and revenue loss.