Aetna considers transpupillary thermotherapy medically necessary for retinoblastoma involving less than 50% of the retina and 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 neovascularization associated with age-related macular degeneration, circumscribed choroidal hemangioma, retinopathy of prematurity and polypoidal choroidal vasculopathy. The stated reason is the lack of prospective, controlled clinical studies supporting its effectiveness for these indications.
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01Billing team: Bill transpupillary thermotherapy for retinoblastoma only when it involves less than 50% of the retina and there are no associated vitreal or sub-retinal seeds at the time of thermotherapy, using ICD-10 codes C69.20 through C69.22.
02Billing team: Bill it for small (2 to 3 mm) choroidal melanomas located posterior in the globe, using ICD-10 codes C69.30 through C69.32.
03Billing team: Transpupillary thermotherapy, combined photodynamic therapy and TTT, and indocyanine green-enhanced TTT have no specific CPT code, and the policy lists them as not covered for the indications it names.
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