Laser Photocoagulation of Drusen — CPB 0609 | AETNA Coverage Update

Aetna modified CPB 0609 for laser photocoagulation of drusen, effective December 4, 2025. CPT 67220 remains non-covered for all drusen-related indications under Aetna plans.

Aetna, a CVS Health company, updated Clinical Policy Bulletin 0609 — its laser photocoagulation of drusen coverage policy — with this December 4, 2025 revision. The policy classifies laser photocoagulation of macular drusen as experimental, investigational, or unproven. That includes sub-threshold laser techniques. Any claim submitted under CPT 67220 for drusen treatment or age-related macular degeneration (AMD) prevention will be denied.

This matters beyond a single procedure. Ophthalmology practices billing Aetna for AMD-related procedures need to know exactly where the line sits — and this policy draws it clearly.

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Quick-Reference: Aetna CPB 0609 Laser Photocoagulation of Drusen

Field	Detail
Payer	Aetna, a CVS Health company
Policy Title	Laser Photocoagulation of Drusen
Policy Code	CPB 0609
Change Type	Modified
Effective Date	December 4, 2025
Impact Level	Medium — direct denial risk for CPT 67220 billed under drusen or AMD diagnoses
Specialties Affected	Ophthalmology, Retinal Surgery, Optometry (referral-based)
Key Action	Remove CPT 67220 from any charge capture template tied to drusen or AMD diagnosis codes before billing Aetna claims dated December 4, 2025 or later

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Aetna Laser Photocoagulation of Drusen Coverage Criteria and Medical Necessity Requirements 2025

The Aetna laser photocoagulation coverage policy under CPB 0609 is straightforward: there are no covered indications for this procedure when used to treat or prevent AMD via macular drusen reduction.

Aetna does not recognize laser photocoagulation — including sub-threshold laser photocoagulation — as meeting medical necessity criteria for drusen treatment. The policy language is unambiguous. The procedure "has not been shown to be effective and may be associated with loss of visual acuity." That's not soft language. Aetna is citing clinical harm as part of its rationale.

Prior authorization for CPT 67220 is irrelevant here. You can't authorize a procedure that's classified as experimental. Getting a prior auth on a non-covered service doesn't create a payment obligation — and your team shouldn't spend time pursuing one for this indication.

The reimbursement risk is real. If your billing team is submitting CPT 67220 paired with any of the ICD-10 codes in this policy — H35.30 through H35.3293 for AMD, H35.361 through H35.369 for macular drusen, or the choroidal degeneration codes in the H31.10x range — expect denial. Confirm whether this CPB applies to your specific Aetna contract type, including any Medicare Advantage arrangements.

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Aetna Laser Photocoagulation of Drusen Exclusions and Non-Covered Indications

This entire policy is an exclusion. Every indication listed in CPB 0609 is non-covered.

Aetna classifies laser photocoagulation of macular drusen — including sub-threshold laser photocoagulation — as experimental, investigational, or unproven. This applies to two distinct use cases: treatment of existing drusen and prevention of AMD progression. Neither is covered.

Aetna's stated rationale is that the procedure "has not been shown to be effective and may be associated with loss of visual acuity." That doesn't make the denial easier to manage, but it does mean this policy isn't going to flip on appeal without extraordinary documentation.

Sub-threshold laser is explicitly called out. If your retina specialist is billing sub-threshold techniques as a distinct approach hoping to sidestep the experimental designation, that won't work under this policy. Aetna groups it in the same non-covered bucket.

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Coverage Indications at a Glance

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Aetna Laser Photocoagulation Billing Guidelines and Action Items 2025

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Laser Photocoagulation of Drusen Under CPB 0609

Not Covered / Experimental CPT Codes

Code	Type	Description	Reason Copy
67220	CPT	Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photocoagulation	Not covered for drusen indications listed in CPB 0609 — classified experimental, investigational, or unproven

Key ICD-10-CM Diagnosis Codes

These are the diagnosis codes Aetna lists in CPB 0609. Pairing CPT 67220 with any of these codes will trigger a claim denial under this coverage policy.

Age-Related Macular Degeneration

Code	Description Copy
H35.30–H35.3293	Age-related macular degeneration (full code range)

Macular Drusen

Drusen of Optic Disc

Choroidal Degeneration, Unspecified

Age-Related Choroidal Atrophy

Diffuse Secondary Atrophy of Choroid

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One more note on the code table: CPT 67220 has other clinical applications beyond drusen. Verify coverage status for non-drusen indications separately with Aetna. Don't let this policy's denial risk bleed into other CPT 67220 claim workflows. Keep your ICD-10 coding precise — the diagnosis code is what triggers the CPB 0609 exclusion.

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