Phototherapy and Photochemotherapy (PUVA) for Skin Conditions — CPB 0205 | AETNA Coverage Update

Aetna modified CPB 0205 covering phototherapy and photochemotherapy (PUVA) for skin conditions, effective September 26, 2025. Here's what billing teams need to know.

Aetna, a CVS Health company, updated CPB 0205 to clarify medical necessity criteria across three treatment modalities: PUVA (CPT 96912), narrow-band UVB (CPT 96900), and the Goeckerman regimen (CPT 96910 and 96913). The update also addresses home phototherapy equipment under HCPCS codes E0691–E0694 and replacement bulbs (A4633). If your practice bills for dermatology phototherapy, this Aetna phototherapy coverage policy change has direct reimbursement implications.

Quick-Reference Table

Aetna Phototherapy and PUVA Coverage Criteria and Medical Necessity Requirements 2025

The CPB 0205 Aetna system update draws clear lines between three treatment types. Each has its own indication list, and getting them mixed up is a fast path to a claim denial.

PUVA (CPT 96912 and 96913) is covered for 20 conditions — but only after conventional therapies have failed. That "failure of conventional therapy" requirement is the biggest medical necessity gate in this policy. Document it explicitly in the patient record before billing.

The covered PUVA indications include: alopecia areata, chronic palmoplantar pustulosis, cutaneous T-cell lymphoma (mycosis fungoides), cutaneous manifestations of graft versus host disease, eosinophilic folliculitis and pruritic eruptions of HIV infection, granuloma annulare, Grover's disease (transient and persistent acantholytic dermatosis), lymphomatoid papulosis, morphea and localized scleroderma lesions, necrobiosis lipoidica, photodermatoses, pityriasis lichenoides, polymorphous light eruption, severe lichen planus, severe parapsoriasis, severe refractory atopic dermatitis/eczema, severe refractory pruritus of polycythemia vera, severe urticaria pigmentosa (cutaneous mastocytosis), severely disabling psoriasis, and vitiligo.

For psoriasis specifically, Aetna defines the frequency limits tightly. Two to three PUVA treatments per week for up to 23 weeks meets medical necessity. After 23 weeks, the policy drops to one treatment every one to three weeks — with most patients expected at once every three weeks. If psoriasis doesn't improve after two months of PUVA therapy, Aetna considers continued treatment not medically necessary. Your utilization review team should flag these cases proactively, not after the denial hits.

Narrow-band UVB phototherapy (CPT 96900) has its own 16-condition indication list. Several of these — atopic dermatitis, psoriasis, lichen planus, granuloma annulare — overlap with the PUVA list. The key distinction: narrow-band UVB does not carry the blanket "conventional therapy failure" prerequisite that PUVA does for most indications. However, three conditions do require failure of prior treatment: cutaneous mastocytosis (after conventional therapies have failed), Kyrle disease (refractory to topical or intralesional therapy), and prurigo nodularis (refractory to topical or intralesional corticosteroids). Uremic pruritus also requires failure of emollients, topical analgesics, and oral antihistamines or gabapentin before narrow-band UVB qualifies.

UVA phototherapy covers 12 indications including acne, eczema, lichen planus, morphea, parapsoriasis, photodermatoses, pityriasis lichenoides, pityriasis rosea, prurigo nodularis, psoriasis, and functionally limiting or symptomatic scleroderma.

The Goeckerman regimen — UVB with topical coal tar, billed under CPT 96910 — is covered only for severe psoriasis affecting more than 10% of body surface area. That threshold mirrors the PUVA psoriasis threshold. Document body surface area in your records every time you bill CPT 96910.

This coverage policy also extends to home phototherapy. Home UVB equipment (HCPCS E0691, E0692, E0693, E0694) qualifies as durable medical equipment (DME) for two patient populations: severe psoriasis patients with frequent flares who can't attend on-site therapy, and atopic dermatitis patients unable to attend on-site therapy. Replacement bulbs under A4633 are also covered when the patient qualifies for home UVB. If you're billing DME for home phototherapy, the "unable to attend on-site therapy" documentation requirement is your audit exposure point.

Prior authorization requirements are not explicitly spelled out in the CPB 0205 policy text, but the medical necessity thresholds — especially "failure of conventional therapy" for PUVA — function as de facto prior auth criteria in practice. If you're billing for PUVA on Aetna patients, expect clinical review on these claims. Confirm your plan-level prior authorization requirements with Aetna directly before the first treatment.

Aetna Phototherapy and PUVA Exclusions and Non-Covered Indications

The policy does not cover CPT 96900 for severe urticaria pigmentosa (cutaneous mastocytosis) under narrow-band UVB. Cutaneous mastocytosis is covered under narrow-band UVB only after conventional therapies have failed — and it's listed as covered when that threshold is met. The exclusion note attached to CPT 96900 flags urticaria pigmentosa specifically, so make sure your documentation clearly establishes conventional therapy failure before billing.

The policy does not address home phototherapy for conditions other than severe psoriasis and atopic dermatitis. Billing home UVB equipment under E0691–E0694 for other indications — vitiligo, lichen planus, parapsoriasis — will likely generate a denial. Don't assume the on-site coverage indication extends automatically to the home equipment codes.

Coverage Indications at a Glance

Aetna Phototherapy Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. Claims with a date of service on or after that date should reflect these updated criteria. Here's what to do now.

CPT, HCPCS, and ICD-10 Codes for Phototherapy and PUVA Under CPB 0205

Covered CPT Codes (When Selection Criteria Are Met)

Covered HCPCS Codes (When Selection Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

This policy covers 447 ICD-10-CM codes in total. The table below covers the primary diagnosis categories relevant to phototherapy billing. Verify the full code list against your Aetna payer contract and the current CPB 0205 policy document.

The full 447-code ICD-10 list spans skin malignancies, lymphomas, autoimmune conditions, and HIV-related dermatoses. Pull the complete list directly from CPB 0205 on the Aetna policy portal to build your billing guidelines reference.