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Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)
Effective date
Not stated in the notice
Identified
Aug 18, 2026
Summary
Aetna considers transpupillary thermotherapy medically necessary for retinoblastoma involving less than 50% of the retina, without associated vitreal or sub-retinal seeds at the time of thermotherapy, and for small (2 to 3 mm) choroidal melanomas located posterior in the globe. Aetna considers transpupillary thermotherapy experimental, investigational, or unproven for all other indications, including central serous chorioretinopathy, choroidal metastases, choroidal neovascularization associated with age-related macular degeneration, polypoidal choroidal vasculopathy, and retinopathy of prematurity.
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What to do
Action · 4 steps
01Billing team: Bill transpupillary thermotherapy as medically necessary only for retinoblastoma involving less than 50% of the retina without associated vitreal or sub-retinal seeds at the time of thermotherapy, or for a small (2 to 3 mm) choroidal melanoma located posterior in the globe.
02Stop billing it as a covered service for the other listed indications, which the policy considers experimental, investigational, or unproven.
03Those indications include choroidal indeterminate melanocytic lesions, choroidal metastases, peripheral retinal hemangioblastoma, retinal astrocytoma, and central serous chorioretinopathy.
04The policy lists combined photodynamic therapy and transpupillary thermotherapy, and indocyanine green-enhanced transpupillary thermotherapy, as not covered for the listed indications and as having no specific CPT code.
Codes mentioned
C69.20C69.22C69.30C69.32C79.49D18.09D31.20D31.22H35.051H35.059H35.101H35.179H35.711H35.719H31.8H32H35.81
Original notice
Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)
aetna.com · Always check the source before changing claims.
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