TL;DR: Aetna, a CVS Health company, modified CPB 0231 governing grenz ray therapy for skin disorders, effective September 26, 2025. Both CPT codes tied to this treatment — 77401 and 96900 — are explicitly not covered for indications listed in the bulletin. Here's what billing teams need to do now.
Grenz ray therapy has always sat in a tricky spot with payers. This update to CPB 0231 Aetna makes the position official and unambiguous: CPT 77401 (radiation treatment delivery, superficial and/or ortho voltage) and CPT 96900 (actinotherapy/ultraviolet light) are non-covered under this policy. If your dermatology or radiation oncology billing team is still submitting these codes for skin disorder indications covered by CPB 0231, expect claim denial. The effective date is September 26, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna (CVS Health) |
| Policy | Grenz Ray Therapy for Skin Disorders |
| Policy Code | CPB 0231 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High — both applicable CPT codes are explicitly non-covered |
| Specialties Affected | Dermatology, Radiation Oncology, Ophthalmology |
| Key Action | Remove CPT 77401 and 96900 from charge capture for grenz ray and UV therapy indications listed in CPB 0231 before September 26, 2025 |
Aetna Grenz Ray Therapy Coverage Criteria and Medical Necessity Requirements 2025
The Aetna grenz ray therapy coverage policy under CPB 0231 is straightforward: there are no covered indications. This isn't a policy that covers grenz ray therapy with conditions attached — it's a blanket non-coverage determination.
Aetna's position is that grenz ray therapy does not meet the standard for medical necessity for any of the skin disorder diagnoses addressed in the bulletin. That's a sweeping stance. The ICD-10 code list attached to this policy runs to 230 codes, spanning infectious and parasitic diseases (A00.0–B99.9), neoplasms (C00.0–D49.9), eyelid and conjunctiva disorders (H00.011–H11.9), capillary diseases (I78.0–I78.9), and varicose veins of the lower extremities (I83.1–I83.9x).
The real issue here is scope. If your practice treats any of those conditions and has ever billed grenz ray or UV therapy under them, this policy applies to you. Prior authorization for these services won't save you — Aetna's position is that these procedures don't meet medical necessity criteria under CPB 0231, full stop.
No prior authorization pathway exists for covered grenz ray therapy billing under this policy because there is no covered pathway. Submitting CPT 77401 or 96900 with any of the listed diagnosis codes is a direct route to claim denial with no appeal based on authorization.
Aetna Grenz Ray Therapy Exclusions and Non-Covered Indications
Both CPT codes listed in CPB 0231 carry a single group designation: "CPT codes not covered for indications listed in the CPB." That's the policy language, and it leaves no room for interpretation.
CPT 77401 covers radiation treatment delivery at superficial and/or ortho voltage, per day. This code is sometimes used in dermatology practices that have legacy superficial radiation equipment or grenz ray units. Under this coverage policy, it's non-covered across all CPB 0231 indications.
CPT 96900 covers actinotherapy using ultraviolet light. This one catches practices off guard more often than 77401. Dermatology teams sometimes bill 96900 for broader phototherapy applications and assume it's covered. Under CPB 0231, it isn't — at least not for the indications Aetna addresses in this bulletin.
This is similar to Aetna's historical treatment of other superficial radiation modalities. The pattern is consistent: the payer evaluates clinical evidence, finds it insufficient to support medical necessity, and issues a non-coverage determination with a broad ICD-10 code list. CPB 0231 fits that mold exactly.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT Codes | Notes |
|---|---|---|---|
| Grenz ray therapy for skin disorders | Not Covered | 77401 | Non-covered per CPB 0231; all listed ICD-10 indications |
| Actinotherapy/UV light for skin disorders | Not Covered | 96900 | Non-covered per CPB 0231; all listed ICD-10 indications |
| Infectious and parasitic skin diseases (A00.0–B99.9) | Not Covered | 77401, 96900 | Grenz ray and UV therapy non-covered for this range |
| Neoplasms (C00.0–D49.9) | Not Covered | 77401, 96900 | Grenz ray and UV therapy non-covered for this range |
| Eyelid and conjunctiva disorders (H00.011–H11.9) | Not Covered | 77401, 96900 | Ophthalmology practices should note this range |
| Capillary diseases (I78.0–I78.9) | Not Covered | 77401, 96900 | Includes telangiectasia and related conditions |
| Varicose veins of lower extremities (I83.x) | Not Covered | 77401, 96900 | Full I83 subcategory range affected |
Aetna Grenz Ray Therapy Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 77401 and 96900 before September 26, 2025. Pull claims from the past 12 months. Identify any that paired these codes with ICD-10 diagnoses in the A00.0–B99.9, C00.0–D49.9, H00.011–H11.9, I78.x, or I83.x ranges. That's your exposure. |
| 2 | Update your charge master to flag CPT 77401 and 96900 for Aetna payer rules. Add a billing edit that stops these codes from going out on Aetna claims for CPB 0231 indications without a compliance review. Your billing software should be able to support a payer-specific edit. |
| 3 | Stop submitting grenz ray therapy billing for Aetna patients with these diagnoses after September 26, 2025. There is no covered pathway. Any claims submitted after the effective date will deny. Reimbursement for these services under Aetna plans is not available under CPB 0231. |
| 4 | Train your dermatology and radiation oncology billing staff on this policy. The 230-code ICD-10 list is wide. Staff need to understand that this policy isn't limited to a narrow set of diagnoses — it covers a broad range of skin and related conditions. If the patient has an Aetna plan and the diagnosis code falls in those ranges, these CPT codes are off the table. |
| 5 | Review your patient financial counseling process. If your practice still offers grenz ray therapy as a clinical service, patients with Aetna coverage need to know before treatment that this is non-covered. Document that conversation. Informed consent around billing applies here, and a patient who expects reimbursement and doesn't get it creates a different kind of problem. |
| 6 | Check other payer policies for CPT 77401 and 96900. Aetna's non-coverage position here may mirror what other commercial payers have done or are about to do. Use this update as a trigger to review your Medicare and Cigna coverage policies for the same codes. The clinical evidence base for grenz ray therapy hasn't strengthened recently — other payers may be moving in the same direction. |
| 7 | Talk to your compliance officer if you're unsure how this applies to your patient mix. If your practice has a high volume of Aetna members and historically billed grenz ray therapy, the claims exposure and patient notification obligations could be significant. Don't wait until after the effective date to sort that out. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Grenz Ray Therapy Under CPB 0231
Not Covered CPT Codes — All Indications in CPB 0231
| Code | Type | Description | Coverage Status |
|---|---|---|---|
| 77401 | CPT | Radiation treatment delivery, superficial and/or ortho voltage, per day | Not Covered |
| 96900 | CPT | Actinotherapy (ultraviolet light) | Not Covered |
Key ICD-10-CM Diagnosis Codes Listed in CPB 0231
These are the diagnosis code ranges and individual codes Aetna lists in this policy. Billing CPT 77401 or 96900 against any of these codes will result in non-covered claim denial.
| Code / Range | Description |
|---|---|
| A00.0–B99.9 | Infectious and parasitic diseases |
| C00.0–D49.9 | Neoplasms |
| H00.011–H02.9 | Disorders and inflammation of eyelids |
| H10.011–H11.9 | Disorders of conjunctiva |
| I78.0 | Diseases of capillaries |
| I78.1 | Diseases of capillaries |
| I78.2 | Diseases of capillaries |
| I78.3 | Diseases of capillaries |
| I78.4 | Diseases of capillaries |
| I78.5 | Diseases of capillaries |
| I78.6 | Diseases of capillaries |
| I78.7 | Diseases of capillaries |
| I78.8 | Diseases of capillaries |
| I78.9 | Diseases of capillaries |
| I83.1–I83.19 | Varicose veins of lower extremities |
| I83.2–I83.29 | Varicose veins of lower extremities |
| I83.3–I83.39 | Varicose veins of lower extremities |
| I83.4–I83.49 | Varicose veins of lower extremities |
| I83.5–I83.59 | Varicose veins of lower extremities |
| I83.6–I83.69 | Varicose veins of lower extremities |
Note: The full policy lists 230 ICD-10-CM codes. The ranges above represent the complete data provided. Review the full CPB 0231 bulletin at the Aetna source for the complete code list before updating your charge capture.
A few things stand out about the ICD-10 scope here. The inclusion of neoplasm codes (C00.0–D49.9) is notable — it signals that Aetna won't cover grenz ray even in oncology-adjacent skin applications. The eyelid and conjunctiva codes (H00.011–H11.9) pull ophthalmology practices into scope. If you run a multispecialty group, this policy touches more departments than a typical dermatology-only bulletin.
The capillary disease codes (I78.0–I78.9) and varicose vein codes (I83.x) extend this into vascular territory. Practices that blend dermatology and vein care should audit across all three specialty billing streams.
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