Aetna Phototherapy & Photochemotherapy (PUVA) for Skin Conditions prior authorization requirements (2026)
What Aetna generally requires to approve Phototherapy & Photochemotherapy (PUVA) for Skin Conditions (CPT 96900, 96910, 96912, 96913), for Commercial plans. Yes. Aetna generally requires prior authorization for Phototherapy & Photochemotherapy (PUVA) for Skin Conditions (CPT 96900, 96910, 96912, 96913).
Medical-necessity criteria Aetna generally applies
Aetna applies medical-necessity review (CPB 0205). PUVA is medically necessary for severely disabling psoriasis (psoriasis involving at least 10% of the body, or severe psoriasis of the hands, feet, or scalp): 2-3 treatments per week for up to 23 weeks, then maintenance 1 treatment every 1-3 weeks; continued PUVA after 2 months without improvement is not medically necessary. UVB with coal tar (Goeckerman) is covered for severe psoriasis (more than 10% BSA). Narrowband UVB and UVA are covered for psoriasis and atopic dermatitis. Home phototherapy (UVB) is covered as DME for severe psoriasis with frequent flares in patients unable to attend on-site therapy, or for atopic dermatitis patients unable to attend on-site therapy; replacement bulbs by prescription are covered.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Phototherapy & Photochemotherapy (PUVA) for Skin Conditions. Confirm the covered diagnosis list against the current Aetna policy.
Related procedure codes
Codes often billed alongside Phototherapy & Photochemotherapy (PUVA) for Skin Conditions: 96900, 96910, 96912, 96913. Verify the correct codes for your documentation.
Commonly required documentation
- Diagnosis and severity/BSA
- for home units, documentation of inability to attend on-site therapy and history of frequent flares.
Situations to verify before submitting
Aetna may not cover Phototherapy & Photochemotherapy (PUVA) for Skin Conditions in these situations. Verify against the current policy rather than assuming a denial:
- Continued PUVA after 2 months without improvement (psoriasis) is not considered medically necessary
How to submit
- Method: Aetna precertification (Availity)
- Portal: Availity
Source
Source: Aetna CPB 0205 Phototherapy and Photochemotherapy (PUVA) for Skin Conditions. Effective/review date not captured from the page render. Last verified 2026-06-17.
Frequently asked questions
Does Aetna require prior authorization for Phototherapy & Photochemotherapy (PUVA) for Skin Conditions?
Yes. Aetna generally requires prior authorization for Phototherapy & Photochemotherapy (PUVA) for Skin Conditions (CPT 96900, 96910, 96912, 96913).
What does Aetna require to approve Phototherapy & Photochemotherapy (PUVA) for Skin Conditions?
Aetna applies medical-necessity review (CPB 0205). PUVA is medically necessary for severely disabling psoriasis (psoriasis involving at least 10% of the body, or severe psoriasis of the hands, feet, or scalp): 2-3 treatments per week for up to 23 weeks, then maintenance 1 treatment every 1-3 weeks; continued PUVA after 2 months without improvement is not medically necessary. UVB with coal tar (Goe… Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Turnaround varies by plan and submission method. Check the Aetna portal for current timeframes.
Submitting Phototherapy & Photochemotherapy (PUVA) for Skin Conditions to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.