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Pulsed Dye Laser Treatment (CPB 0559, reviewed 2026-09-18)
Effective date
Not stated in the notice
Identified
Oct 1, 2026
Summary
Aetna's Clinical Policy Bulletin 0559 covers pulsed dye laser treatment. It considers the pulsed dye laser medically necessary for conditions including actinic keratoses that have not adequately responded to imiquimod, 5-FU or cryosurgery, infantile hemangiomas, port wine stains and hemangiomas on the face and neck, and verrucae after at least two conventional therapies have failed. It considers the laser experimental, investigational or unproven for other indications such as active acne, onychomycosis and non-melanoma skin cancer, and cosmetic for conditions such as rosacea, solar lentigines and striae distensae.
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What to do
Action · 4 steps
01Billing team: For verrucae (warts), bill CPT 17110 or 17111 for pulsed dye laser only after at least two of topical chemotherapy, curettage, electrodesiccation and cryotherapy have been tried and failed.
02For actinic keratoses (CPT 17000, 17003, 17004; diagnosis L57.0), document that the member did not adequately respond to topical imiquimod or 5-FU, or to cryosurgery.
03For port wine stains and other hemangiomas (CPT 17106, 17107, 17108), bill when the lesions are on the face and neck, using diagnosis codes D18.01, I78.8 or Q82.5.
04Stop scheduling or billing pulsed dye laser for the experimental indications the policy lists, such as active acne, onychomycosis and non-melanoma skin cancer, and for the cosmetic indications it lists, such as rosacea, solar lentigines and striae distensae.
Codes mentioned
1700017003170041710617107171081711017111172601726117262172631726417266172701727117272172731727417276172801728117282172831728417286969209692196922B08.1B07.0B07.9L98.0D18.01I78.8Q82.5L57.0L40.0
Original notice
Pulsed Dye Laser Treatment (CPB 0559, reviewed 2026-09-18)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Pulsed Dye Laser Treatment (CPB 0559, reviewed 2025-08-22)MediumNo effective date · Medical PolicyLaser Treatment for Psoriasis and Other Selected Skin Conditions (CPB 0577, reviewed 2026-07-15)MediumNo effective date · Medical PolicyBenign Skin Lesion Removal (CPB 0633, reviewed 2026-09-09)MediumNo effective date · Medical PolicyCarbon Dioxide Laser (CPB 0427, reviewed 2026-07-08)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesDermatologyENT (Ear, Nose & Throat)DentistryPediatricsCode 17000Code 17003Code 17004Code 17106Code 17107Code 17108Code 17110Code 17111Code 17260Code 17261Code 17262Code 17263Code 17264Code 17266Code 17270Code 17271Code 17272Code 17273Code 17274Code 17276Code 17280Code 17281Code 17282Code 17283Code 17284Code 17286Code 96920Code 96921Code 96922Code B08.1Code B07.0Code B07.9Code L98.0Code D18.01Code I78.8Code Q82.5Code L57.0Code L40.0