Radiation Treatment for Selected Nononcologic Indications — CPB 0551 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0551 — its coverage policy for radiation treatment in non-oncologic indications — effective February 27, 2026. If your team bills CPT codes 77401–77417, 77436–77439, 77767–77772, or 77778 for conditions like keloids, heterotopic ossification, Ledderhose disease, pterygium, or osteoarthritis, this policy governs your reimbursement and your medical necessity documentation.

Aetna Non-Oncologic Radiation Coverage Criteria and Medical Necessity Requirements 2026

The Aetna non-oncologic radiation coverage policy under CPB 0551 covers a specific, narrow set of indications. Each one has hard clinical criteria. If the documentation doesn't match those criteria exactly, expect a claim denial.

Here's what Aetna covers — and what each indication actually requires.

Keloids (ICD-10 L91.0)
Aetna covers low-dose or high-dose radiation as adjunctive therapy after excisional keloid removal. The timing window is strict: treatment must begin within seven days of surgery. This isn't advisory — it's a hard cutoff. Miss that window and you've lost coverage, regardless of how complete the rest of the record is. Keloid removal itself must also meet medical necessity criteria under Aetna CPB 0031 (Cosmetic Surgery). Make sure both sides of that are documented before you bill CPT 77402, 77767, or 77778.

Heterotopic Ossification Prevention
Aetna covers radiation therapy for prevention of heterotopic ossification — but only in high-risk patients. The policy defines high risk as: previous heterotopic ossification, ankylosing spondylitis (M08.1, M45.0–M45.9), diffuse idiopathic skeletal hyperostosis, spinal stenosis (M48.0–M48.8), unlimited hip motion preoperatively, or head injury (S06.0x0A–S06.9x9S). Document which high-risk factor applies before treatment proceeds.

Ledderhose Disease / Plantar Fibromatosis (ICD-10 M72.2)
Radiation therapy for plantar fibromatosis is covered when conventional treatments have failed. The policy specifically names tamoxifen, verapamil, and steroid injections as those conventional treatments. Document treatment failure in the record before billing.

Pterygium
Aetna covers beta irradiation (CPT 77401–77417, which include beta irradiation per the policy) for prevention of primary or recurrent pterygium when the condition cannot be managed medically.

Osteoarthritis (ICD-10 M15.0–M19.93)
This is the most criteria-heavy indication in CPB 0551. Aetna requires all four of the following:

That fourth criterion is the one that gets claims denied. Pull the orthopedic consult note before billing radiation treatment for osteoarthritis. The consultation must confirm both that the disease is advanced enough for joint replacement and that the patient was deemed medically inoperable.

Aetna Non-Oncologic Radiation Exclusions and Non-Covered Indications

Two indications are explicitly off the table under CPB 0551.

TRASER Device for Nasal Telangiectasias (ICD-10 I78.1)
Aetna classifies the TRASER (Total Reflection Amplification of Spontaneous Emission Radiation) device as experimental, investigational, and unproven for treating nasal telangiectasias. Effectiveness has not been established. Don't bill it and don't expect an appeal to land — experimental designations rarely move without new peer-reviewed evidence submitted through the payer's clinical review process.

Ablative Radiotherapy for Cardiac Arrhythmia (ICD-10 I49.1–I49.9)
Ablative radiotherapy for any cardiac arrhythmia diagnosis — I49.1 through I49.9 — is also classified as experimental and unproven. CPT 77373 and 77435 (stereotactic body radiation therapy delivery and management) are explicitly listed as not covered for indications in this policy. If your electrophysiology group or a hospital-based radiation oncology program is exploring this modality for arrhythmia management, document that treatment as research. Do not bill it as a covered service under CPB 0551.

Coverage Indications at a Glance

Aetna Non-Oncologic Radiation Billing Guidelines and Action Items 2026

The effective date of February 27, 2026 is already here. These action items are not future-tense — they're for your next billing cycle.

If your case mix includes high-volume radiation oncology billed against non-cancer diagnoses, loop in your compliance officer before the next billing cycle. The multi-layered criteria here — especially for osteoarthritis and heterotopic ossification — create real exposure if documentation habits haven't kept pace with Aetna's requirements.

CPT, HCPCS, and ICD-10 Codes for Non-Oncologic Radiation Under CPB 0551

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered / Experimental CPT Codes

Key ICD-10-CM Diagnosis Codes