CommercialCoverageHigh impact
Phototherapy for Acne (CPB 0656, reviewed 2026-09-15)
Aetna·Dermatology, General Practice, Family Medicine +1 more·Medical Policy
We identified it
Sep 30, 2026
Summary
Aetna's updated Clinical Policy Bulletin 0656 (effective 2026-09-15) classifies nearly all phototherapy and laser treatments for acne as experimental, investigational, or unproven, including popular systems like AviClear Laser, ClearLight, Omnilux Blue, and home-based light devices. Billing teams must deny or require prior authorization for all phototherapy acne claims using the listed CPT and HCPCS codes unless alternative coverage criteria are met.
Action Required
IMMEDIATE: Billing team must update claim editing rules in billing software to DENY or flag for prior authorization review all claims containing CPT codes 0232T, 17110, 17111, 96567, 96570, 96571, 96573, 96910, 96912, 96913, 96920-96922, HCPCS codes E0200, E0205, E0691-E0694, J7308, J7309, J7345, and P9020 when billed for acne treatment (ICD-10 codes L70.0-L70.9) or related indications (post-acne erythema L53.8, atrophic acne scar L90.5, hidradenitis suppurativa L73.2). Update claim denial templates to cite CPB 0656 and specify that phototherapy for acne is considered experimental/investigational. Flag any AviClear Laser System, ClearLight, Omnilux Blue, or home-based light device treatments for automatic denial. Notify providers via email of this non-coverage determination. Train front-desk and billing staff to obtain prior authorization on all phototherapy acne claims or counsel patients regarding out-of-pocket responsibility. Failure to deny these claims will result in inappropriate reimbursement for non-covered services.