Total Body Photography, Dermoscopy and Other Selected Noninvasive Dermatologic Tests — CPB 0188 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0188 covering total body photography and dermoscopy, effective December 18, 2025. Here's what your billing team needs to act on now.

Aetna's updated dermoscopy and total body photography coverage policy tightens the line between covered services and technologies it considers experimental. The policy governs CPT 96904 as the primary covered code and places a long list of newer diagnostic tools — including CPT codes 96931–96936 (reflectance confocal microscopy), 0658T (electrical impedance spectroscopy), 0700T–0701T (molecular fluorescent imaging), and 0089U (DermTech gene expression) — firmly in the "not covered" column. If your dermatology billing team uses any of these codes for Aetna members, this update is a direct denial risk.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Total Body Photography, Dermoscopy and Other Selected Noninvasive Dermatologic Tests
Policy Code	CPB 0188
Change Type	Modified
Effective Date	December 18, 2025
Impact Level	High
Specialties Affected	Dermatology, Plastic Surgery, Oncology (Cutaneous)
Key Action	Audit any claims billing experimental codes (0089U, 0658T, 96931–96936, 0700T–0701T) for Aetna members and stop submitting them without an appeal strategy in place

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Aetna Total Body Photography and Dermoscopy Coverage Criteria and Medical Necessity Requirements 2025

CPB 0188 Aetna's coverage policy draws a clear box around what qualifies for reimbursement. Aetna covers total body photography (TBP) and dermoscopy — also called epiluminescence microscopy (ELM), digital epiluminescence microscopy (DELM), dermatoscopy, skin videomicroscopy, or in-vivo cutaneous surface microscopy — only when documented medical necessity exists.

Medical necessity applies when a member has a personal history or close family history of at least one of the following:

A member doesn't need a personal diagnosis — a close family history of any of the covered conditions can also qualify. Document that family history explicitly in the medical record. This is a common miss that triggers claim denial.

The repeat study rule is just as important. Aetna does not consider repeat TBP or dermoscopy medically necessary more often than every 24 months. Bill CPT 96904 more frequently than that without a strong medical justification and you'll get denied. Document the clinical reasoning explicitly if your dermatologist believes a shorter interval is warranted — don't assume the claim will pass without it.

Dermoscopy billing under this policy hinges on the indication. The covered indications above are narrow. Aetna doesn't extend this coverage policy broadly — any indication outside those four categories falls into experimental territory.

Prior authorization requirements are not explicitly detailed in CPB 0188's criteria section, but given Aetna's history with specialty imaging services, verify prior auth requirements for CPT 96904 through Aetna's portal before scheduling. Assuming no prior auth is required for a "simple" dermoscopy visit is how reimbursement problems start.

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Aetna Dermoscopy and TBP Exclusions and Non-Covered Indications

This is the section that carries the most financial exposure. Aetna's list of experimental, investigational, or unproven services under CPB 0188 is long — and it covers technologies that some practices are actively using and billing.

Computerized TBP systems are not covered. Aetna explicitly calls out MelaFind, MoleMapCD, and MoleMate. These systems have not shown better health outcomes than conventional TBP, per Aetna's assessment. If your practice uses a computerized TBP platform and bills it for Aetna members, you are billing into a wall.

Dermoscopy for the following indications is also not covered:

#	Excluded Procedure Copy
1	Assessment of vulvar intraepithelial neoplasia
2	Delineation of basal cell carcinoma for Mohs micrographic surgery (CPT 17311–17315 are listed as related codes, but dermoscopy for BCC delineation pre-Mohs is excluded)
3	Evaluation of non-parasitic skin infections

That Mohs exclusion is worth flagging. Some practices use dermoscopy to help delineate BCC margins before Mohs. Aetna will not cover dermoscopy for this purpose. Keep those services separate in documentation and billing.

The experimental list for evaluating dysplastic and atypical nevi is extensive. Aetna considers the following technologies unproven for early melanoma detection:

The RCM codes alone represent significant reimbursement exposure. CPT 96931–96936 describe reflectance confocal microscopy for cellular and sub-cellular skin imaging. These codes have been growing in use in advanced dermatology practices. Aetna is not paying for them under this coverage policy.

The DermTech PLA (0089U) exclusion is also notable. This non-invasive gene expression patch test has been marketed as a way to reduce unnecessary biopsies. Aetna's position is that its predictive clinical value hasn't been established. Don't bill it expecting payment from Aetna members.

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Coverage Indications at a Glance

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Aetna Dermoscopy Billing Guidelines and Action Items 2025

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Dermoscopy and Total Body Photography Under CPB 0188

Covered CPT Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
96904	CPT	Whole body integumentary photography, for monitoring of high-risk patients with dysplastic nevus syndrome

Not Covered / Experimental CPT Codes

Key ICD-10-CM Diagnosis Codes

Note: The full policy lists 81 ICD-10-CM codes. Review the complete list at CPB 0188 on Aetna's site to confirm applicable diagnosis codes for your patient mix.

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If your practice offers advanced dermatologic imaging — RCM, OCT, gene expression testing — and you have a significant Aetna patient population, talk to your compliance officer before the December 18, 2025 effective date. The experimental list in CPB 0188 is broad. Some of these exclusions will surprise practices that have been billing these codes without denial. Better to audit now than to unwind six months of denied claims in Q1 2026.

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