All PlansCoverageMedium impact
Epiretinal Radiation Therapy (CPB 0756, reviewed 2026-10-21)
Aetna·Ophthalmology·Medical Policy
We identified it
Oct 25, 2026
Summary
Aetna's Clinical Policy Bulletin 0756 (reviewed 2026-10-21) classifies epiretinal radiation therapy as experimental, investigational, or unproven for age-related macular degeneration and other conditions due to insufficient evidence of effectiveness. This is a coverage denial policy—the procedure is not covered by Aetna, and claims for epiretinal radiation therapy will be denied.
Action Required
Billing team must verify current applicability of this policy with Aetna. Confirm whether epiretinal radiation therapy claims have been historically denied under CPB 0756 and ensure that any current or pending claims for this procedure are not submitted for reimbursement or are submitted with clear expectation of denial. If a patient requests this treatment, front desk or authorization staff should notify them that Aetna classifies this procedure as experimental/investigational and will not cover it. Update internal coverage lists and decision support tools to reflect that CPT code 67036 (vitrectomy, mechanical, pars plana approach) when performed in conjunction with epiretinal radiation therapy delivery is not separately reimbursable for this indication under Aetna plans. Retain related policy cross-references (CPB 0270, 0404, 0409, 0490, 0594, 0609, 0685, 0701) in case alternative therapies are being considered for wet AMD.