Grenz Ray Therapy for Skin Disorders
Customize your policy alerts
Sign up for Aetna Policy 0231 alerts
Get alerted when Policy 0231 changes without checking for updates manually.
Monitor payer policy activity
This policy governs Aetna's coverage stance on the use of Grenz ray (ultrasoft x-ray) therapy for dermatologic conditions and applies to Aetna members and treating providers.
No material clinical or coverage changes in this revision.
Coverage Criteria
Experimental and Investigational
Covered when ALL of the following are met:
Policy statement - therapy not covered as medically necessary
Radiation therapy is contraindicated for benign cutaneous lesions, particularly for dermatoses of the head and neck, because published observations report radiation-induced skin tumors and other neoplasms following such exposures. The policy notes that although Grenz ray therapy has been proposed for benign dermatoses unresponsive to conventional treatments, this use remains controversial in the peer-reviewed literature and carries documented safety concerns.
Aetna considers Grenz ray therapy experimental and investigational for the treatment of dermatologic conditions due to inadequate evidence in the published peer‑reviewed medical literature regarding its effectiveness. As a result, Grenz ray therapy is not established as medically necessary for skin disorders and may be denied on that basis.
Coding
| A00.0 - B99.9 | Infectious and parasitic diseases |
| C00.0 - D49.9 | Neoplasms |
| L00 - L99 | Diseases of the skin and subcutaneous tissue |
| Z51.0 | Encounter for antineoplastic radiation therapy |
Provider Actions & Billing
Billing codes noted — CPT/HCPCS/ICD-10
Billing/Coding: CPT/HCPCS/ICD-10 guidance is provided in the policy. CPT codes called out include 77401 (radiation treatment delivery, superficial and/or orthovoltage, per day), 96900 (actinotherapy - ultraviolet light), and when appropriate an unlisted radiation procedure code (e.g., 77499) may be required for Grenz ray therapy. ICD-10 groups listed as examples of diagnoses not covered for indications in this CPB include L00-L99 (diseases of the skin and subcutaneous tissue) and multiple other ranges noted in the policy. Providers should bill using the most appropriate code and may need to use an unlisted code when a specific Grenz ray code is not available.
Prior authorization — none specified
Prior authorization: None specified in these policy sections. No prior authorization requirements are detailed for Grenz ray therapy in the provided document excerpts.
Provider note & denial-risk
Provider note: Grenz ray (borderline or ultrasoft x‑ray) has been proposed for benign dermatoses unresponsive to conventional therapy, but its use remains controversial. Published reports of radiation‑induced skin tumors indicate radiation therapy is contraindicated for benign cutaneous lesions, particularly for head and neck dermatoses. Aetna considers Grenz ray therapy experimental and investigational for dermatologic conditions due to inadequate evidence of effectiveness; claims may be denied as not medically necessary.
- Grenz ray therapy considered experimental/investigational — denial risk for not medically necessary
Step therapy — none specified
Step therapy: No step therapy requirements are specified in these document sections.
Policy review history and effective/next dates
Policy review history: Effective date: 1998-04-22. Last review: 03/29/2023. Next scheduled review: 2024-02-22. Review history and definitions are available via the policy links.
- Effective date: 1998-04-22
- Last review: 2023-03-29
- Next review: 2024-02-22
- Links: Review History, Definitions
Supplemental documentation links
Supplemental documentation and resources are linked in the policy for provider reference, including Aetna glossary, program provisions, legal notices, plan disclosures, and other Aetna resources. External links are provided for convenience; Aetna is not responsible for content on external sites.
- Glossary
- Program Provisions
- Legal Notices
- Plan Disclosures
- Aetna main resources and accessibility/legal pages
Provider actions summary — none additional stated
Provider actions summary: No additional provider actions are specified in these chunks beyond billing guidance, coding considerations, and awareness of the policy designation (experimental/investigational) which may result in claim denial.
- No other provider actions stated in these sections
Background
Grenz rays are long‑wavelength, low‑energy (ultrasoft) x‑rays with very limited skin penetration, primarily absorbed within the most superficial layers of the skin (approximately the first ~2 mm). Historically they have been investigated for multiple inflammatory and benign skin disorders. Typical regimens described in the literature include weekly exposures (for example, around 200 R per session for a total of about 800–1,000 R), with the possibility of retreatment after several months and cumulative doses reported in some series up to about 5,000 R. Despite these historical uses, concerns about long‑term cancer risk and the limited quality of evidence supporting efficacy have led to their classification as an experimental therapy for dermatologic conditions.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.