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Laser Photocoagulation of Drusen (CPB 0609, reviewed 2026-09-03)
Act
immediately
Effective date
Not stated in the notice
Identified
Oct 5, 2026
Summary
Aetna has reaffirmed that laser photocoagulation of drusen (CPT 67220), including sub-threshold laser photocoagulation, is considered experimental, investigational, or unproven for prevention and treatment of age-related macular degeneration and is NOT covered. Claims for this procedure with specified ICD-10 diagnoses will be denied. This policy was reviewed/updated on September 3, 2026.
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What to do
immediately · 5 steps
01Billing team must update the electronic health record (EHR) and billing system to flag CPT 67220 claims as non-covered when submitted with any of the listed ICD-10 diagnosis codes (H31.101-H31.109, H31.111-H31.119, H31.121-H31.129, H35.30-H35.3293, H35.361-H35.369, H47.321-H47.329).
02Configure system to automatically deny or reject these claims before submission.
03Notify all ophthalmologists and retinal specialists that Aetna will not reimburse for laser photocoagulation of drusen for age-related macular degeneration prevention or treatment.
04Update patient financial counseling protocols to inform patients this procedure is not covered and they will be responsible for all costs.
05Do not submit claims for prior authorization—they will be denied as experimental/unproven.
If missed: Failure to implement this will result in claim denials and potential patient billing issues.
Codes mentioned
67220H31.101H31.102H31.103H31.104H31.105H31.106H31.107H31.108H31.109H31.111H31.112H31.113H31.114H31.115H31.116H31.117H31.118H31.119H31.121H31.122H31.123H31.124H31.125H31.126H31.127H31.128H31.129H35.30H35.3293H35.361H35.362H35.363H35.364H35.365H35.366H35.367H35.368H35.369H47.321H47.322H47.323H47.324H47.325H47.326H47.327H47.328H47.329
Original notice
Laser Photocoagulation of Drusen (CPB 0609, reviewed 2026-09-03)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Laser Photocoagulation of Drusen (CPB 0609, reviewed 2025-12-02)MediumEffective Dec 2, 2025 · Medical PolicyExtended Ophthalmoscopy (CPB 0767, reviewed 2025-12-02)MediumNo effective date · Medical PolicyArtificial Retina and Artificial Iris (CPB 0713, reviewed 2026-10-15)MediumNo effective date · Medical PolicyBrachytherapy (CPB 0371, reviewed 2026-05-20)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesOphthalmologyCode 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 H35.3293Code 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