TL;DR: Aetna, a CVS Health company, modified CPB 0656 covering phototherapy for acne, effective October 4, 2025. Every phototherapy and light-based treatment for acne vulgaris, acne inversa, and cystic acne falls under this policy — and Aetna denies all of them.
This update to the Aetna phototherapy acne coverage policy is a sweeping experimental designation. No phototherapy approach for acne gets coverage — not PDT, not laser, not LED, not home devices. If your dermatology or med spa billing team is submitting claims for CPT 96567, 96573, 17110, 96920, or any of the 13 CPT codes listed under CPB 0656 for acne diagnoses, these combinations will be denied as experimental under CPB 0656. Here's what changes for billing teams.
Quick-Reference: Aetna CPB 0656 Phototherapy for Acne (2025)
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Phototherapy for Acne — CPB 0656 |
| Policy Code | CPB 0656 |
| Change Type | Modified |
| Effective Date | October 4, 2025 |
| Impact Level | High |
| Specialties Affected | Dermatology, plastic surgery, med spa |
| Key Action | Audit all active charges for CPT 96567, 96573, 17110, 96920–96922, and HCPCS J7308, J7345 billed with L70.x or L73.2 diagnoses — stop billing these combinations immediately |
Aetna Phototherapy for Acne Coverage Criteria and Medical Necessity Requirements 2025
There are no coverage criteria to meet here. That's the real issue.
Aetna's CPB 0656 coverage policy contains zero covered indications for phototherapy when the diagnosis is acne. The entire policy is structured around what Aetna considers experimental, investigational, or unproven. Every modality — laser, PDT, LED, intense pulsed light, photopneumatic therapy — fails Aetna's medical necessity standard for acne vulgaris.
The policy covers three patient populations: acne vulgaris (L70.x codes), acne inversa or hidradenitis suppurativa (L73.2), and cystic acne of the scalp. All three get the same answer — not covered.
For acne vulgaris, Aetna cites insufficient evidence of effectiveness compared to established treatments. The policy doesn't define "established treatments," but the implication is topical retinoids, antibiotics, oral isotretinoin, and similar first-line options. If you're billing phototherapy for patients who haven't exhausted those options, your claim denial risk doubles.
Note: This policy contains no prior authorization criteria. As a general billing practice guideline, submitting PA requests for services designated as experimental is unlikely to result in approval.
Aetna Phototherapy for Acne Exclusions and Non-Covered Indications
This is the entire policy. Every treatment listed below is experimental, investigational, or unproven under CPB 0656.
For acne vulgaris, Aetna excludes:
| # | Excluded Procedure |
|---|---|
| 1 | Bio-responsive nano-architectonics-integrated microneedle patches |
| 2 | Chlorin e6-mediated photodynamic therapy (PDT) |
| 3 | Combined LED light therapy and chromophore gel |
| 4 | Gold nano-shell-mediated photothermal therapy |
| 5 | Gold and silver nanoparticles, alone or with phototherapy |
| 6 | Indocyanine green-based PDT |
| 7 | Intense pulsed light |
| 8 | Intradermal tranexamic acid injection for post-acne erythema (billed with L53.8) |
| 9 | Laser systems — this list is long and specific: AviClear, Candela Smooth Beam, Erbium glass, Erbium YAG, fractional photothermolysis, pulsed dye laser, Nd:YAG |
| 10 | Light-emitting diode (LED) therapy |
| 11 | Nano-pulse stimulation (including the CellFX System) |
| 12 | Non-ablative fractional photothermolysis before aminolevulinic acid (ALA)-PDT |
| 13 | Photochemotherapy (cross-referenced to CPB 0205) |
| 14 | Photodynamic therapy — including the ClearLight Acne PhotoClearing System and Omnilux Blue PDT |
| 15 | Blue light therapy with topical aminolevulinic acid (Levulan Kerastick, billed with J7308 or J7345) or methylene blue nano-formulation |
| 16 | Photopneumatic therapy |
| 17 | Platelet-rich plasma as adjuvant therapy for atrophic acne scars (billed with CPT 0232T or HCPCS P9020 under L90.5) |
| 18 | Tri-needle pretreatment combined with ALA-PDT |
Home-based devices are explicitly excluded. Aetna calls out devices delivering heat or pulsed heat, laser therapy, light or pulsed light, suction, ultraviolet therapy, or any combination. HCPCS codes E0200, E0205, E0691, E0692, E0693, and E0694 billed for acne diagnoses all land in non-covered territory.
For acne inversa (hidradenitis suppurativa, L73.2), Aetna excludes laser therapy (pulsed dye and Nd:YAG), PDT with blue light and 5-ALA or Levulan, and phototherapy or light therapy of any kind.
For cystic acne of the scalp, combined surgery and PDT is excluded.
For nodulocystic acne, Aetna considers fire needle pre-treatment with 5-aminolevulinic acid photodynamic therapy combined with isotretinoin experimental, investigational, or unproven. The policy treats this as a separate exclusion — not a subset of the acne vulgaris list — because the evidence question is specific to this combined treatment approach.
The breadth here is unusual. Most payer policies carve out at least one emerging technology as conditionally covered. Aetna's position is categorical — there is no phototherapy approach for acne that meets their medical necessity standard.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Acne vulgaris — photodynamic therapy (PDT) | Not Covered / Experimental | CPT 96567, 96573; HCPCS J7308, J7345 | Includes blue light with ALA (Levulan Kerastick) |
| Acne vulgaris — laser therapy (any type) | Not Covered / Experimental | CPT 96920, 96921, 96922, 17110, 17111 | Includes AviClear, pulsed dye, Nd:YAG, Erbium |
| Acne vulgaris — LED light therapy | Not Covered / Experimental | CPT 96567 | Includes combined LED + chromophore gel |
| Acne vulgaris — intense pulsed light | Not Covered / Experimental | CPT 96567 | — |
| Acne vulgaris — photopneumatic therapy | Not Covered / Experimental | No specific CPT listed | — |
| Acne vulgaris — platelet-rich plasma (atrophic acne scar) | Not Covered / Experimental | CPT 0232T; HCPCS P9020 | Diagnosis L90.5 |
| Acne vulgaris — home-based devices | Not Covered / Experimental | HCPCS E0200, E0205, E0691–E0694 | Heat, light, UV, suction, laser devices |
| Post-acne erythema — intradermal tranexamic acid injection | Not Covered / Experimental | No specific CPT listed | Diagnosis L53.8 |
| Acne inversa / hidradenitis suppurativa — all phototherapy | Not Covered / Experimental | CPT 96567, 96573, 96920–96922 | Diagnosis L73.2 |
| Cystic acne of scalp — combined surgery + PDT | Not Covered / Experimental | CPT 96567, 96573 | — |
| Nodulocystic acne — fire needle + ALA-PDT + isotretinoin | Not Covered / Experimental | CPT 96573 | — |
| Acne vulgaris — photochemotherapy (PUVA) | Not Covered / Experimental | CPT 96910, 96912, 96913 | Cross-reference CPB 0205 |
Aetna Phototherapy for Acne Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge master and superbill before October 4, 2025. Pull every charge line that pairs a phototherapy CPT (96567, 96573, 96570, 96571, 96920, 96921, 96922, 17110, 17111) or photochemotherapy CPT (96910, 96912, 96913) with any L70.x, L73.2, L53.8, or L90.5 ICD-10 code. Flag those combinations as non-covered for Aetna patients immediately. The effective date of October 4, 2025 is the hard cutoff — claims submitted after that date with these combinations are at heightened denial risk. |
| 2 | Stop billing HCPCS J7308 and J7345 for acne diagnoses. Aminolevulinic acid (Levulan Kerastick, billed as J7308, and the 10% gel form billed as J7345) is explicitly non-covered when used for acne photodynamic therapy under CPB 0656. These drugs have legitimate coverage for actinic keratoses under other policies — confirm the diagnosis code is accurate before billing. |
| 3 | Remove home device codes from acne-related billing. HCPCS E0200, E0205, E0691, E0692, E0693, and E0694 billed for acne diagnoses will deny. If your durable medical equipment billing includes these codes for any L70.x patient, flag them now. |
| 4 | Update your financial counseling scripts for acne patients. If your practice offers AviClear, ClearLight, Omnilux Blue, or any pulsed dye laser for acne, tell Aetna patients upfront that no phototherapy acne billing will be reimbursed under their plan. Get a signed ABN or patient financial responsibility form before treatment. This protects you on the back end. |
| 5 | Check CPT 0232T and HCPCS P9020 for PRP billing. Platelet-rich plasma as adjuvant therapy for atrophic acne scars (L90.5) is non-covered. If your practice offers PRP for acne scarring, the same financial counseling rule applies — Aetna won't pay. |
| 6 | Cross-reference CPB 0205 for any photochemotherapy claims. Aetna's CPB 0656 redirects photochemotherapy (PUVA) to CPB 0205. That policy may cover PUVA for other skin conditions — but not for acne. Don't assume CPT 96910, 96912, or 96913 gets covered just because it appears in a different policy context. |
If you're running a high-volume dermatology practice or med spa with significant Aetna patient volume, talk to your compliance officer before the October 4, 2025 effective date. The scope of excluded services here is broad enough that a systematic audit — not a spot check — is the right move.
| 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 Phototherapy for Acne Under CPB 0656
Not Covered / Experimental CPT Codes
All 13 CPT codes under CPB 0656 are classified as experimental for acne diagnoses.
| Code | Type | Description | Coverage Status |
|---|---|---|---|
| 0232T | CPT | Injection(s), platelet-rich plasma, any site, including image guidance, harvesting and preparation | Not Covered (experimental for atrophic acne scar) |
| 17110 | CPT | Destruction of benign lesions (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), up to 14 lesions | Not Covered |
| 17111 | CPT | Destruction of benign lesions, 15 or more lesions | Not Covered |
| 96567 | CPT | Photodynamic therapy by external application of light to destroy pre-malignant and/or malignant lesions | Not Covered for acne diagnoses |
| +96570 | CPT | Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug | Not Covered |
| +96571 | CPT | Each additional 15 minutes (add-on to 96570) | Not Covered |
| 96573 | CPT | Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa | Not Covered for acne diagnoses |
| 96910 | CPT | Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B | Not Covered for acne diagnoses |
| 96912 | CPT | Photochemotherapy; psoralens and ultraviolet A (PUVA) | Not Covered for acne diagnoses |
| 96913 | CPT | Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive dermatoses requiring at least 4–8 hours of care | Not Covered for acne diagnoses |
| 96920 | CPT | Laser treatment for inflammatory skin disease (psoriasis); less than 250 sq cm | Not Covered for acne diagnoses |
| 96921 | CPT | Laser treatment for inflammatory skin disease (psoriasis); 250–500 sq cm | Not Covered for acne diagnoses |
| 96922 | CPT | Laser treatment for inflammatory skin disease (psoriasis); over 500 sq cm | Not Covered for acne diagnoses |
Not Covered / Experimental HCPCS Codes
| Code | Type | Description | Coverage Status |
|---|---|---|---|
| E0200 | HCPCS | Heat lamp, without stand (table model), includes bulb or infrared element | Not Covered for acne diagnoses |
| E0205 | HCPCS | Heat lamp, with stand, includes bulb or infrared element | Not Covered for acne diagnoses |
| E0691 | HCPCS | Ultraviolet light therapy system | Not Covered for acne diagnoses |
| E0692 | HCPCS | Ultraviolet light therapy system | Not Covered for acne diagnoses |
| E0693 | HCPCS | Ultraviolet light therapy system | Not Covered for acne diagnoses |
| E0694 | HCPCS | Ultraviolet light therapy system | Not Covered for acne diagnoses |
| J7308 | HCPCS | Aminolevulinic acid HCl for topical administration, 20%, single unit dosage form (354 mg) | Not Covered for acne diagnoses |
| J7309 | HCPCS | Methyl aminolevulinate (MAL) for topical administration, 16.8%, 1 gram [product discontinued] | Not Covered for acne diagnoses |
| J7345 | HCPCS | Aminolevulinic acid HCl for topical administration, 10% gel, 10 mg | Not Covered for acne diagnoses |
| P9020 | HCPCS | Platelet-rich plasma, each unit | Not Covered for acne diagnoses |
Key ICD-10-CM Diagnosis Codes Affected by CPB 0656
| Code | Description |
|---|---|
| L53.8 | Other specified erythematous conditions (post-acne erythema) |
| L70.0 | Acne vulgaris |
| L70.1 | Acne conglobata |
| L70.2 | Acne varioliformis |
| L70.3 | Acne tropica |
| L70.4 | Infantile acne |
| L70.5 | Acné excoriée |
| L70.6 | Other acneiform disorders |
| L70.7 | Acne vulgaris, unspecified |
| L70.8 | Other acne |
| L70.9 | Acne, unspecified |
| L73.2 | Hidradenitis suppurativa |
| L90.5 | Scar conditions and fibrosis of skin (atrophic acne scar) |
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