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Benign Skin Lesion Removal (CPB 0633, reviewed 2025-09-25)
Effective date
Not stated in the notice
Identified
Aug 14, 2026
Summary
This is historical material: Aetna's Clinical Policy Bulletin 0633 on benign skin lesion removal, last reviewed 2025-09-25 and first detected by PolicyChanges on 2026-08-14. Aetna covers removal of common benign lesions (such as moles, skin tags, sebaceous cysts, seborrheic keratoses and dermatofibromas) only when a listed medical reason is documented, such as a biopsy showing dysplasia or malignancy, recurrent irritation, symptoms, inflammation, infection or a lesion that blocks vision, and treats removal without those reasons as cosmetic. No effective date is stated, so confirm this is the current version before relying on it.
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What to do
Action · 6 steps
01No effective date is stated, so confirm the current version of Aetna CPB 0633 before changing any workflow.
02Billing team: before billing removal of a benign lesion (such as a mole, skin tag, sebaceous cyst, seborrheic keratosis or dermatofibroma) to Aetna as medically necessary, confirm the chart documents one of the listed reasons: a pathology result suggesting dysplasia or malignancy, recurrent trauma from location, suspicious features (asymmetry, irregular border, uneven color, diameter over 6 mm, or change over time), symptoms such as bleeding, burning or itching, inflammation, infection, or restriction of vision or a body opening.
03Providers: where none of those reasons applies, the source treats the removal as cosmetic, so tell the patient before the procedure and document the discussion.
04Billing team: do not bill ionized plasma jet therapy or pre-surgical skin ultrasound to Aetna, since the source treats both as experimental and has no specific code for them, and do not use the preprocedural or screening Z-codes (Z01.818, Z01.89, Z13.89) to support skin ultrasound.
05Billing team: the source does not state any patient billing rule for cosmetic removal, so do not bill the patient for it unless the patient's plan documents allow it.
06The source does not state a denial consequence, so do not assume one.
Codes mentioned
171101711164788647906479267840A63.0B08.1D48.5I78.1L72.0L72.3L98.0Q82.5L57.0K13.21L57.3L73.8Z01.818Z01.89Z13.89
Original notice
Benign Skin Lesion Removal (CPB 0633, reviewed 2025-09-25)
aetna.com · Always check the source before changing claims.
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