Stereotactic Radiosurgery — CPB 0083 | AETNA Coverage Update

Aetna modified CPB 0083 for stereotactic radiosurgery, effective September 26, 2025. Here's what billing teams need to know.

Aetna, a CVS Health company, updated its stereotactic radiosurgery coverage policy under CPB 0083 Aetna system, shifting full medical necessity criteria to eviCore Healthcare's Radiation Therapy Clinical Guidelines. If your team bills CPT 61796, 61797, 61798, 61799, 63620, 77371, 77372, 77373, or any of the other 14 CPT and six HCPCS codes tied to this policy, your authorization and documentation workflow runs through eviCore now — not Aetna's internal criteria. That's the change that matters.

Quick-Reference Table

Aetna Stereotactic Radiosurgery Coverage Criteria and Medical Necessity Requirements 2025

The core shift in this update is delegation. Aetna now defers all medical necessity criteria for stereotactic radiosurgery to eviCore Healthcare's Radiation Therapy Clinical Guidelines. Aetna's internal CPB 0083 no longer publishes the criteria itself.

That means when you need to know whether a case qualifies — cranial lesion, spinal lesion, SBRT for thoracic targets — you go to eviCore, not Aetna's policy page. The guidelines live at eviCore's provider portal under the Radiation Oncology solution.

This matters for prior authorization. If your team submits PA requests for CPT 61796 (single simple cranial lesion), CPT 61798 (single complex cranial lesion), CPT 63620 (single spinal lesion), or SBRT delivery via CPT 77373 or G0563, the criteria Aetna's reviewers apply come from eviCore. Your PA package needs to align with eviCore's language, not language pulled from an old version of CPB 0083.

One thing to watch: eviCore updates its guidelines on a formal annual cycle, but reserves the right to change them without advance notice. Draft guidelines post 90 days before implementation. Build a habit of checking eviCore's portal before submitting complex cases — don't assume last quarter's criteria still apply.

The covered diagnosis codes under this policy run the full range. Malignant neoplasms (C00.0–C96.9) are the primary driver. But Aetna also covers stereotactic radiosurgery for benign conditions: essential tremor (G25.0), Parkinson's disease (G20.A1–G20.C), epilepsy (G40.001–G40.919), trigeminal neuralgia (which maps to the cluster headache and TAC code range G44.1–G44.39), and hemangiomas (D18.0–D18.9). Each of these has its own clinical threshold in eviCore's guidelines.

Reimbursement for these services depends entirely on whether your documentation satisfies the eviCore criteria at the time of authorization. A mismatch between your clinical notes and the current eviCore guideline language is your fastest path to claim denial.

Coverage Indications at a Glance

Aetna Stereotactic Radiosurgery Billing Guidelines and Action Items 2025

The eviCore delegation is already live as of the September 26, 2025 effective date. If your team hasn't updated its workflows yet, do it now.

If your mix includes a high volume of functional SRS — essential tremor, Parkinson's, refractory epilepsy — talk to your compliance officer before the end of October 2025. The eviCore criteria for these indications are specific, and the documentation bar is higher than for oncology cases.

CPT, HCPCS, and ICD-10 Codes for Stereotactic Radiosurgery Under CPB 0083

Covered CPT Codes (When Selection Criteria Are Met)

Covered HCPCS Codes (When Selection Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

The full ICD-10 list under CPB 0083 includes 133 codes. The ranges above cover the primary diagnosis categories. Review the full code list at the CPB 0083 source policy for complete detail.