CommercialCoverageMedium impact
Epiretinal Radiation Therapy (CPB 0756, reviewed 2025-12-02)
Aetna·Ophthalmology, Radiation Oncology·Medical Policy
Effective date
Dec 2, 2025
We identified it
Aug 14, 2026
Summary
Aetna has classified Epiretinal Radiation Therapy (CPB 0756) as experimental, investigational, or unproven for age-related macular degeneration and all other conditions, effective immediately. This means claims for epiretinal radiation therapy will not be covered by Aetna and must be denied. Billing teams must implement denial protocols and inform providers that this procedure is not a covered benefit.
Action Required
By December 2, 2025: Billing team must configure denial protocols in the billing system to automatically deny all claims for epiretinal radiation therapy (associated with CPT 67036 and ICD-10 codes H35.30-H35.389 for macular degeneration). Update claim rejection templates to communicate to providers and patients that this procedure is classified as experimental/investigational and is not a covered benefit under Aetna plans. Notify ophthalmology providers in writing of this coverage determination. Implement system edits to flag any submitted claims for this procedure as non-covered. Failure to implement these denials will result in claim payment errors and compliance violations.