CommercialCoverageMedium impact
Actinic Keratoses Treatments (CPB 0567, reviewed 2026-08-21)
Aetna·Dermatology, General Surgery, Plastic Surgery·Medical Policy
We identified it
Sep 29, 2026
Summary
Aetna's updated Clinical Policy Bulletin 0567 (effective 2026-08-21) clarifies coverage for actinic keratoses treatments, specifying which destructive methods (cryosurgery, topical agents, curettage/excision, and advanced therapies like laser and PDT) are medically necessary, while designating specific experimental treatments as non-covered. Billing teams must ensure claims are submitted only for covered procedures with appropriate CPT codes and medical documentation, and reject claims for experimental modalities like intense pulsed light, microneedling, and thermal PDT.
Action Required
Immediately: Billing team must update payer rules in billing software to identify and deny all claims for experimental actinic keratoses treatments including CPT codes for intense pulsed light, non-ablative fractional thulium laser, microneedling, microwave therapy, thermal photodynamic therapy, reflectance confocal microscopy (RCM), and repetitive daylight PDT. For covered procedures (CPT 11300-11313, 11400-11406, 11420-11426, 11440-11446, 15780-15789, 15786-15787, 17000-17004, 96567, 96573, 96574, J7308, J7345, S0117), ensure diagnosis code L57.0 is present on all claims. Train coders to append diagnosis L57.0 to all actinic keratosis treatment claims. Update billing system templates to require documentation that patient failed topical imiquimod or 5-FU or cryosurgery before approving advanced therapies (chemical peel, dermabrasion, laser, PDT). Reject any claims submitted without this escalation documentation. Update compliance monitoring to flag claims for experimental treatments and hold for provider education.