Aetna · Clinical coverage policy

Aetna Cold Laser and High-Power Laser Therapies coverage criteria

Aetna covers low-level (cold) laser therapy as medically necessary only to prevent oral mucositis in cancer patients at increased risk because of chemotherapy, radiotherapy, and/or hematopoietic stem cell transplantation. For all other uses — including high-power (Class IV) laser therapy and dynamic-energy low-level laser therapy across 54 listed musculoskeletal, neurological, dermatologic, dental, oncologic, and pain indications — it is considered experimental, investigational, or unproven due to inadequate evidence of effectiveness.

Policy CPB 0363 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0363

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0363 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Cold Laser and High-Power Laser Therapies (CPT 0552T), and what gets it denied?

Path
Aetna covers low-level (cold) laser therapy as medically necessary only to prevent oral mucositis in cancer patients at increased risk because of chemotherapy, radiotherapy, and/or hematopoietic stem cell transplantation. For all other uses — including high-power (Class IV) laser therapy and dynamic-energy low-level laser therapy across 54 listed musculoskeletal, neurological, dermatologic, dental, oncologic, and pain indications — it is considered experimental, investigational, or unproven due to inadequate evidence of effectiveness. Coverage criteria include: Aetna considers low-level laser therapy medically necessary for prevention of oral mucositis in persons undergoing cancer treatment associated with increased risk of oral mucositis, including (ONE or more of the following cancer treatments): chemotherapy and/or radiotherapy, and/or hematopoietic stem cell transplantation.. Applies to 2 codes: 0552T, S8948.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Aetna considers cold laser therapy (also known as low-level laser therapy or class III laser), high-power laser therapy (class IV therapeutic laser), and low-level laser therapy using dynamic photonic and dynamic thermokinetic energies experimental, investigational, or unproven for the following indications (not an all-inclusive list) because there is inadequate evidence of effectiveness for these indications.; Experimental/investigational/unproven indication: Achilles tendinopathy; Experimental/investigational/unproven indication: Alzheimer's disease; Experimental/investigational/unproven indication: Amyotrophic lateral sclerosis; Experimental/investigational/unproven indication: Bone regeneration / bone healing; Experimental/investigational/unproven indication: Breast implant capsular contracture; Experimental/investigational/unproven indication: Burning mouth syndrome; Experimental/investigational/unproven indication: Cardio-protection following myocardial infarction; Experimental/investigational/unproven indication: Carpal tunnel syndrome; Experimental/investigational/unproven indication: Colorectal cancer; Experimental/investigational/unproven indication: Cubital tunnel syndrome; Experimental/investigational/unproven indication: Dementia; Experimental/investigational/unproven indication: Dental pain; Experimental/investigational/unproven indication: Dentin hypersensitivity; Experimental/investigational/unproven indication: Depression; Experimental/investigational/unproven indication: Elbow disorders; Experimental/investigational/unproven indication: Fibromyalgia; Experimental/investigational/unproven indication: Hair loss (including alopecia areata and androgenic alopecia); Experimental/investigational/unproven indication: Hamstring injuries; Experimental/investigational/unproven indication: Head and neck cancer; Experimental/investigational/unproven indication: Heart failure; Experimental/investigational/unproven indication: Herpes labialis; Experimental/investigational/unproven indication: Hypothyroidism induced by autoimmune thyroiditis; Experimental/investigational/unproven indication: Inferior alveolar nerve and lingual nerve injuries; Experimental/investigational/unproven indication: Keratosis pilaris; Experimental/investigational/unproven indication: Knee osteoarthritis; Experimental/investigational/unproven indication: Lymphedema; Experimental/investigational/unproven indication: Melasma; Experimental/investigational/unproven indication: Multiple sclerosis; Experimental/investigational/unproven indication: Musculoskeletal dysfunction; Experimental/investigational/unproven indication: Myofascial pain syndrome; Experimental/investigational/unproven indication: Neurological dysfunctions; Experimental/investigational/unproven indication: Neuropathic orofacial pain (e.g., burning mouth syndrome, occipital neuralgia, and trigeminal neuralgia); Experimental/investigational/unproven indication: Obesity; Experimental/investigational/unproven indication: Oral lichen planus; Experimental/investigational/unproven indication: Oral ulcers in chronic graft-versus-host disease (GVHD); Experimental/investigational/unproven indication: Pain relief (e.g., acute and chronic low back pain / neck pain, orthodontic pain, neuropathic pain, shoulder pain); Experimental/investigational/unproven indication: Parkinson's disease; Experimental/investigational/unproven indication: Patella-femoral pain syndrome; Experimental/investigational/unproven indication: Pemphigus vulgaris; Experimental/investigational/unproven indication: Peri-implant mucositis; Experimental/investigational/unproven indication: Periodontitis; Experimental/investigational/unproven indication: Physical therapy (including rehabilitation following carpal tunnel release); Experimental/investigational/unproven indication: Plantar fascial fibromatosis / plantar fasciitis; Experimental/investigational/unproven indication: Recurrent aphthous stomatitis / ulcers; Experimental/investigational/unproven indication: Reduction of pain, edema, and trismus after orthognathic surgery; Experimental/investigational/unproven indication: Rheumatoid arthritis; Experimental/investigational/unproven indication: Shoulder impingement syndrome; Experimental/investigational/unproven indication: Skin burn; Experimental/investigational/unproven indication: Stroke; Experimental/investigational/unproven indication: Temporomandibular joint (TMJ) disorders; Experimental/investigational/unproven indication: Tendon repair; Experimental/investigational/unproven indication: Tinnitus; Experimental/investigational/unproven indication: Traumatic brain injury; Experimental/investigational/unproven indication: Wound healing (including diabetic ulcers, following hammertoe surgery, gingival healing, and pressure ulcers). Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0363 — Cold Laser and High-Power Laser Therapies

Coverage criteria

  • Aetna considers low-level laser therapy medically necessary for prevention of oral mucositis in persons undergoing cancer treatment associated with increased risk of oral mucositis, including (ONE or more of the following cancer treatments): chemotherapy and/or radiotherapy, and/or hematopoietic stem cell transplantation.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Cold Laser and High-Power Laser Therapies (CPT 0552T), and what gets it denied?
Aetna covers low-level (cold) laser therapy as medically necessary only to prevent oral mucositis in cancer patients at increased risk because of chemotherapy, radiotherapy, and/or hematopoietic stem cell transplantation. For all other uses — including high-power (Class IV) laser therapy and dynamic-energy low-level laser therapy across 54 listed musculoskeletal, neurological, dermatologic, dental, oncologic, and pain indications — it is considered experimental, investigational, or unproven due to inadequate evidence of effectiveness. Coverage criteria include: Aetna considers low-level laser therapy medically necessary for prevention of oral mucositis in persons undergoing cancer treatment associated with increased risk of oral mucositis, including (ONE or more of the following cancer treatments): chemotherapy and/or radiotherapy, and/or hematopoietic stem cell transplantation.. Applies to 2 codes: 0552T, S8948. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Aetna considers cold laser therapy (also known as low-level laser therapy or class III laser), high-power laser therapy (class IV therapeutic laser), and low-level laser therapy using dynamic photonic and dynamic thermokinetic energies experimental, investigational, or unproven for the following indications (not an all-inclusive list) because there is inadequate evidence of effectiveness for these indications.; Experimental/investigational/unproven indication: Achilles tendinopathy; Experimental/investigational/unproven indication: Alzheimer's disease; Experimental/investigational/unproven indication: Amyotrophic lateral sclerosis; Experimental/investigational/unproven indication: Bone regeneration / bone healing; Experimental/investigational/unproven indication: Breast implant capsular contracture; Experimental/investigational/unproven indication: Burning mouth syndrome; Experimental/investigational/unproven indication: Cardio-protection following myocardial infarction; Experimental/investigational/unproven indication: Carpal tunnel syndrome; Experimental/investigational/unproven indication: Colorectal cancer; Experimental/investigational/unproven indication: Cubital tunnel syndrome; Experimental/investigational/unproven indication: Dementia; Experimental/investigational/unproven indication: Dental pain; Experimental/investigational/unproven indication: Dentin hypersensitivity; Experimental/investigational/unproven indication: Depression; Experimental/investigational/unproven indication: Elbow disorders; Experimental/investigational/unproven indication: Fibromyalgia; Experimental/investigational/unproven indication: Hair loss (including alopecia areata and androgenic alopecia); Experimental/investigational/unproven indication: Hamstring injuries; Experimental/investigational/unproven indication: Head and neck cancer; Experimental/investigational/unproven indication: Heart failure; Experimental/investigational/unproven indication: Herpes labialis; Experimental/investigational/unproven indication: Hypothyroidism induced by autoimmune thyroiditis; Experimental/investigational/unproven indication: Inferior alveolar nerve and lingual nerve injuries; Experimental/investigational/unproven indication: Keratosis pilaris; Experimental/investigational/unproven indication: Knee osteoarthritis; Experimental/investigational/unproven indication: Lymphedema; Experimental/investigational/unproven indication: Melasma; Experimental/investigational/unproven indication: Multiple sclerosis; Experimental/investigational/unproven indication: Musculoskeletal dysfunction; Experimental/investigational/unproven indication: Myofascial pain syndrome; Experimental/investigational/unproven indication: Neurological dysfunctions; Experimental/investigational/unproven indication: Neuropathic orofacial pain (e.g., burning mouth syndrome, occipital neuralgia, and trigeminal neuralgia); Experimental/investigational/unproven indication: Obesity; Experimental/investigational/unproven indication: Oral lichen planus; Experimental/investigational/unproven indication: Oral ulcers in chronic graft-versus-host disease (GVHD); Experimental/investigational/unproven indication: Pain relief (e.g., acute and chronic low back pain / neck pain, orthodontic pain, neuropathic pain, shoulder pain); Experimental/investigational/unproven indication: Parkinson's disease; Experimental/investigational/unproven indication: Patella-femoral pain syndrome; Experimental/investigational/unproven indication: Pemphigus vulgaris; Experimental/investigational/unproven indication: Peri-implant mucositis; Experimental/investigational/unproven indication: Periodontitis; Experimental/investigational/unproven indication: Physical therapy (including rehabilitation following carpal tunnel release); Experimental/investigational/unproven indication: Plantar fascial fibromatosis / plantar fasciitis; Experimental/investigational/unproven indication: Recurrent aphthous stomatitis / ulcers; Experimental/investigational/unproven indication: Reduction of pain, edema, and trismus after orthognathic surgery; Experimental/investigational/unproven indication: Rheumatoid arthritis; Experimental/investigational/unproven indication: Shoulder impingement syndrome; Experimental/investigational/unproven indication: Skin burn; Experimental/investigational/unproven indication: Stroke; Experimental/investigational/unproven indication: Temporomandibular joint (TMJ) disorders; Experimental/investigational/unproven indication: Tendon repair; Experimental/investigational/unproven indication: Tinnitus; Experimental/investigational/unproven indication: Traumatic brain injury; Experimental/investigational/unproven indication: Wound healing (including diabetic ulcers, following hammertoe surgery, gingival healing, and pressure ulcers). Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Cold Laser and High-Power Laser Therapies?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Cold Laser and High-Power Laser Therapies?
Policy exclusions and limitations: Aetna considers cold laser therapy (also known as low-level laser therapy or class III laser), high-power laser therapy (class IV therapeutic laser), and low-level laser therapy using dynamic photonic and dynamic thermokinetic energies experimental, investigational, or unproven for the following indications (not an all-inclusive list) because there is inadequate evidence of effectiveness for these indications.; Experimental/investigational/unproven indication: Achilles tendinopathy; Experimental/investigational/unproven indication: Alzheimer's disease; Experimental/investigational/unproven indication: Amyotrophic lateral sclerosis; Experimental/investigational/unproven indication: Bone regeneration / bone healing; Experimental/investigational/unproven indication: Breast implant capsular contracture; Experimental/investigational/unproven indication: Burning mouth syndrome; Experimental/investigational/unproven indication: Cardio-protection following myocardial infarction; Experimental/investigational/unproven indication: Carpal tunnel syndrome; Experimental/investigational/unproven indication: Colorectal cancer; Experimental/investigational/unproven indication: Cubital tunnel syndrome; Experimental/investigational/unproven indication: Dementia; Experimental/investigational/unproven indication: Dental pain; Experimental/investigational/unproven indication: Dentin hypersensitivity; Experimental/investigational/unproven indication: Depression; Experimental/investigational/unproven indication: Elbow disorders; Experimental/investigational/unproven indication: Fibromyalgia; Experimental/investigational/unproven indication: Hair loss (including alopecia areata and androgenic alopecia); Experimental/investigational/unproven indication: Hamstring injuries; Experimental/investigational/unproven indication: Head and neck cancer; Experimental/investigational/unproven indication: Heart failure; Experimental/investigational/unproven indication: Herpes labialis; Experimental/investigational/unproven indication: Hypothyroidism induced by autoimmune thyroiditis; Experimental/investigational/unproven indication: Inferior alveolar nerve and lingual nerve injuries; Experimental/investigational/unproven indication: Keratosis pilaris; Experimental/investigational/unproven indication: Knee osteoarthritis; Experimental/investigational/unproven indication: Lymphedema; Experimental/investigational/unproven indication: Melasma; Experimental/investigational/unproven indication: Multiple sclerosis; Experimental/investigational/unproven indication: Musculoskeletal dysfunction; Experimental/investigational/unproven indication: Myofascial pain syndrome; Experimental/investigational/unproven indication: Neurological dysfunctions; Experimental/investigational/unproven indication: Neuropathic orofacial pain (e.g., burning mouth syndrome, occipital neuralgia, and trigeminal neuralgia); Experimental/investigational/unproven indication: Obesity; Experimental/investigational/unproven indication: Oral lichen planus; Experimental/investigational/unproven indication: Oral ulcers in chronic graft-versus-host disease (GVHD); Experimental/investigational/unproven indication: Pain relief (e.g., acute and chronic low back pain / neck pain, orthodontic pain, neuropathic pain, shoulder pain); Experimental/investigational/unproven indication: Parkinson's disease; Experimental/investigational/unproven indication: Patella-femoral pain syndrome; Experimental/investigational/unproven indication: Pemphigus vulgaris; Experimental/investigational/unproven indication: Peri-implant mucositis; Experimental/investigational/unproven indication: Periodontitis; Experimental/investigational/unproven indication: Physical therapy (including rehabilitation following carpal tunnel release); Experimental/investigational/unproven indication: Plantar fascial fibromatosis / plantar fasciitis; Experimental/investigational/unproven indication: Recurrent aphthous stomatitis / ulcers; Experimental/investigational/unproven indication: Reduction of pain, edema, and trismus after orthognathic surgery; Experimental/investigational/unproven indication: Rheumatoid arthritis; Experimental/investigational/unproven indication: Shoulder impingement syndrome; Experimental/investigational/unproven indication: Skin burn; Experimental/investigational/unproven indication: Stroke; Experimental/investigational/unproven indication: Temporomandibular joint (TMJ) disorders; Experimental/investigational/unproven indication: Tendon repair; Experimental/investigational/unproven indication: Tinnitus; Experimental/investigational/unproven indication: Traumatic brain injury; Experimental/investigational/unproven indication: Wound healing (including diabetic ulcers, following hammertoe surgery, gingival healing, and pressure ulcers). Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0363 — Cold Laser and High-Power Laser Therapies

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0363 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.