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Laser Photocoagulation of Drusen (CPB 0609, reviewed 2025-12-02)
Act
immediately
Effective date
Dec 2, 2025
Identified
Aug 18, 2026
Summary
Aetna has reinforced that laser photocoagulation of drusen (CPT 67220), including sub-threshold laser photocoagulation, for age-related macular degeneration prevention and treatment remains experimental, investigational, or unproven and is NOT covered. Claims for this procedure with related ICD-10 codes will be denied. This policy was reviewed/updated on 2025-12-02.
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What to do
immediately · 5 steps
01Billing team must update denial protocols and billing system software to automatically deny or route for manual review all claims for CPT 67220 (laser photocoagulation of drusen) when billed with any of the listed ICD-10 codes related to choroidal degeneration, age-related macular degeneration, or drusen.
02Verify that encounter forms and provider dashboards clearly flag this code as non-covered/experimental for these diagnoses.
03Add CPT 67220 to the non-covered procedure list for Aetna plans.
04Educate providers and front desk staff that prior authorization requests for this procedure will be denied.
05Any claims submitted will result in automatic denial; do not waste resources pursuing appeals without new clinical evidence of effectiveness.
Codes mentioned
67220H31.101H31.102H31.103H31.104H31.105H31.106H31.107H31.108H31.109H31.111H31.112H31.113H31.114H31.115H31.116H31.117H31.118H31.119H31.121H31.122H31.123H31.124H31.125H31.126H31.127H31.128H31.129H35.30H35.31H35.32H35.33H35.3293H35.361H35.362H35.363H35.364H35.365H35.366H35.367H35.368H35.369H47.321H47.322H47.323H47.324H47.325H47.326H47.327H47.328H47.329
Original notice
Laser Photocoagulation of Drusen (CPB 0609, reviewed 2025-12-02)
aetna.com · Always check the source before changing claims.
Related changes
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Related policy hubs
Aetna policiesOphthalmologyOptometryCode 67220Code H31.101Code H31.102Code H31.103Code H31.104Code H31.105Code H31.106Code H31.107Code H31.108Code H31.109Code H31.111Code H31.112Code H31.113Code H31.114Code H31.115Code H31.116Code H31.117Code H31.118Code H31.119Code H31.121Code H31.122Code H31.123Code H31.124Code H31.125Code H31.126Code H31.127Code H31.128Code H31.129Code H35.30Code H35.31Code H35.32Code H35.33Code H35.3293Code H35.361Code H35.362Code H35.363Code H35.364Code H35.365Code H35.366Code H35.367Code H35.368Code H35.369Code H47.321Code H47.322Code H47.323Code H47.324Code H47.325Code H47.326Code H47.327Code H47.328Code H47.329