Management of Meibomian Glands — CPB 0797 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0797 governing meibomian gland management, effective November 21, 2025. Every major intervention for meibomian gland dysfunction — including LipiFlow, intense pulsed light, and the TearCare System — is classified as experimental. Here's what billing teams need to do.

This update to the Aetna meibomian gland dysfunction coverage policy affects CPT codes 0207T, 0330T, 0507T, 0552T, 0563T, and 68040, plus HCPCS codes G0460 and P9020. If your ophthalmology or optometry practice bills any of these to Aetna, expect denials unless you're already prepared. The policy leaves almost no room for reimbursement on the newer device-based treatments your patients may be requesting.

Quick-Reference Table

Aetna Meibomian Gland Dysfunction Coverage Criteria and Medical Necessity Requirements 2025

The short version: Aetna's CPB 0797 Aetna system does not cover the devices and procedures that have become standard offerings in many dry eye clinics. The coverage policy draws a hard line. Treatments that have grown into significant revenue drivers for ophthalmology and optometry practices are explicitly non-covered.

Aetna does not recognize medical necessity for device-based thermal pulsation (LipiFlow, CPT 0207T), wearable heat-delivery devices (TearCare System, CPT 0563T), or tear film imaging (LipiView, CPT 0330T). Near-infrared dual imaging with the LipiScan Dynamic Meibomian Imager (CPT 0507T) is also excluded. These are not edge cases — they are the core diagnostic and treatment tools that many practices have built meibomian gland dysfunction (MGD) programs around.

The policy also excludes intense pulsed light therapy (IPL) for MGD. IPL has been gaining traction as a treatment, and some practices have started billing it with expectation of coverage. Under CPB 0797, that reimbursement will not come from Aetna. There is no prior authorization pathway that makes these covered — Aetna's position is that the clinical evidence doesn't support coverage, full stop.

Expression of conjunctival follicles (CPT 68040) is called out separately with a broader note: it's considered experimental, investigational, unproven, AND not medically necessary for chalazion, dry eyes, hordeolum, and meibomian gland dysfunction. That language matters. "Not medically necessary" language in a coverage policy tends to generate harder denials than "experimental" designations alone.

If your practice treats Aetna members for any of these conditions, your billing team should know that no amount of documentation will make these covered under the current policy. The question isn't how to document medical necessity — it's whether you have the right financial counseling conversations before delivering these services.

Aetna Meibomian Gland Dysfunction Exclusions and Non-Covered Indications

This section is essentially the entire policy. Aetna classifies every major MGD intervention as experimental, investigational, or unproven. That's not an overstatement — the policy lists 13 specific treatment categories and four diagnostic approaches, all excluded.

The device exclusions cover both ends of the treatment pathway. On the diagnostic side, Aetna excludes tear film imaging (LipiView, CPT 0330T), in-vivo confocal microscopy, and near-infrared dual imaging (LipiScan, CPT 0507T). Without covered diagnostics, the entire workflow collapses from a reimbursement standpoint.

On the treatment side, the excluded list includes some surprising entries alongside the expected ones. Androgens, autologous platelet-rich plasma drops (HCPCS G0460 and P9020), and umbilical cord-derived mesenchymal stem cell eye-drop therapy are excluded — those are newer or emerging approaches. But so are intra-ductal probing, meibomian gland probing, and the RedTouch laser (CPT 0552T). These are not experimental in the sense of being brand-new. Aetna's position is that the evidence base hasn't cleared the bar.

Combined intense pulsed light and photo-biomodulation — specifically the Eye-Light System — is also excluded. This is the same pattern Aetna has applied in other specialty areas: combination device therapies tend to face extra scrutiny when the individual components are already non-covered.

The quantum molecular resonance electrotherapy device (Rexon-Eye) and subconjunctival sirolimus-loaded liposomes round out the list. If your practice offers any of these, patient financial responsibility conversations need to happen before treatment — not after the claim denies.

Coverage Indications at a Glance

Aetna Meibomian Gland Dysfunction Billing Guidelines and Action Items 2025

The effective date of November 21, 2025 has passed. That means claims for these services billed to Aetna on or after that date — and arguably claims already in your accounts receivable — are subject to denial under this policy. Here's what to do now.

CPT, HCPCS, and ICD-10 Codes for Meibomian Gland Management Under CPB 0797

Not Covered / Experimental CPT Codes

All CPT codes listed in this policy are non-covered for meibomian gland dysfunction and related indications. There are no covered CPT codes in CPB 0797.

Not Covered HCPCS Codes

Key ICD-10-CM Diagnosis Codes

These codes appear in CPB 0797. Claims pairing these diagnoses with the CPT/HCPCS codes above will generate claim denial under Aetna's coverage policy.

The full ICD-10-CM list in CPB 0797 includes 94 codes. Confirm the complete list at the Aetna CPB 0797 source document.