CommercialCoverageMedium impact
Actinic Keratoses Treatments (CPB 0567, reviewed 2026-04-10)
Aetna·Dermatology·Medical Policy
Effective date
Apr 10, 2026
We identified it
Aug 12, 2026
Summary
Aetna's updated Actinic Keratoses policy (CPB 0567, effective 2026-04-10) clarifies coverage for first-line treatments (cryosurgery, topical medications) and establishes a clear pathway for advanced therapies (chemical peels, dermabrasion, laser, PDT) only after failure of initial treatments. The policy also designates several emerging treatments as experimental/unproven, which will not be covered. Billing teams must ensure prior authorization captures treatment history and failure documentation before authorizing advanced procedures.
Action Required
By 2026-04-10, the billing team must: (1) Update prior authorization workflows to require documentation of failed initial therapy (cryosurgery, topical imiquimod, or 5-FU) before approving advanced procedures (CPT 15780-15789, 17000-17004, 96567, 96573, 96574). (2) Create a mandatory checklist in the prior auth system requiring providers to document which first-line treatment was attempted and reason for failure when requesting chemical peels, dermabrasion, laser therapy, or PDT. (3) Flag and deny any claims for experimental treatments: intense pulsed light, non-ablative fractional thulium laser, microneedling, microwave therapy, thermal PDT, reflectance confocal microscopy (96931-96936), topical calcipotriol, topical piroxicam, topical vitamin D analogs, and repetitive daylight PDT — these codes have no coverage. (4) Ensure billing software blocks HCPCS J7309 (discontinued MAL) from being submitted. (5) Train providers and front-desk staff on new medical necessity requirements. Claims submitted without documented treatment failure will be denied.