Actinic Keratoses Treatments

Aetna covers first‑line AK treatments — cryosurgery with liquid nitrogen, topical diclofenac 3% gel, imiquimod 5% cream, ingenol mebutate gel, and 5‑fluorouracil (with/without tretinoin) — and allows curettage/excision only when squamous cell carcinoma is suspected and histologic analysis is needed; chemical peels, dermabrasion, laser therapy and photodynamic therapy are medically necessary only after inadequate response to imiquimod or 5‑FU or to cryosurgery. Interventions considered experimental/investigational and not covered include creams with sunscreen/piroxicam/retinoic/glycolic gel, intense pulsed light, lapatinib, microneedling, microwave therapy, non‑ablative fractional thulium laser, thermal photodynamic therapy, topical calcipotriol/piroxicam/vitamin D/analogs, and repetitive daylight PDT for prevention (several of which are also excluded by CPT-coded service policy).

"Topical diclofenac sodium 3% gel for AK (described as an effective alternative topical therapy)."