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 before claims go out the door.

Aetna, a CVS Health company, updated its stereotactic radiosurgery coverage policy under CPB 0083 on September 26, 2025. The update shifts medical necessity criteria to eviCore Healthcare's Radiation Therapy Clinical Guidelines — meaning your approval criteria now live outside the Aetna policy document itself. If your team bills CPT 61796, 61797, 61798, 61799, 77371, 77372, 77373, or any of the 14 CPT and six HCPCS codes in this policy, this change affects how you document and seek prior authorization for every case.

Quick-Reference Table

Aetna Stereotactic Radiosurgery Coverage Criteria and Medical Necessity Requirements 2025

The real story in CPB 0083 Aetna is this: Aetna no longer maintains its own detailed medical necessity criteria inside the policy document. Instead, it points you to eviCore Healthcare's Radiation Therapy Clinical Guidelines as the governing standard. That's a meaningful structural shift.

What it means in practice is that your coverage policy source of truth is now a third-party document that eviCore can update without prior notice. Aetna's policy says explicitly: eviCore "reserves the right to change and update the guidelines without prior notice." Draft guidelines post 90 days before implementation — but that's eviCore's clock, not a guarantee you'll catch every revision.

For stereotactic radiosurgery billing, this matters a lot. SRS cases often involve high reimbursement, complex prior authorization requirements, and payor scrutiny on medical necessity. If your clinical documentation doesn't match eviCore's current criteria at the time of review, you're looking at a claim denial — even if the patient genuinely needed the procedure.

Bookmark the eviCore Radiation Therapy Clinical Guidelines page directly. Check it before submitting prior auth for any case billing CPT 61796 through 61800, CPT 63620, 63621, 77371, 77372, 77373, 77432, or 77435. The eviCore guidelines cover both cranial SRS and stereotactic body radiation therapy (SBRT), so your SBRT cases under 77373 and HCPCS C9795 are equally affected.

The covered diagnosis range is wide. ICD-10 codes C00–C96.9 (malignant neoplasms) are the most common pathway, but the policy also covers benign diagnoses — D33.0 through D33.2 for benign brain tumors, D18.0 through D18.9 for hemangiomas and hemangioblastomas, and functional indications including G25.0 (essential tremor), G20.A1–G20.C (Parkinson's disease), G40-series epilepsy codes, and trigeminal neuralgia-adjacent headache codes G44.1 through G44.39. The full ICD-10 list runs 133 codes — don't assume your diagnosis maps cleanly without checking.

Coverage Indications at a Glance

Aetna Stereotactic Radiosurgery Billing Guidelines and Action Items 2025

The effective date of September 26, 2025, is already past. If you haven't updated your workflow yet, do it now.

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 in CPB 0083 runs 133 codes. The ranges above cover the major diagnostic categories. Confirm your specific ICD-10 code falls within these ranges before submitting — Aetna's eviCore review will flag diagnosis-to-procedure mismatches quickly.