TL;DR: Aetna, a CVS Health company, modified CPB 0181 covering evoked potential studies, effective September 26, 2025. Here's what changes for billing teams.
This update to the Aetna evoked potential studies coverage policy affects 21 CPT codes across auditory, visual, somatosensory, and vestibular testing. CPB 0181 Aetna governs which evoked potential studies qualify for reimbursement and which Aetna considers not covered—and the covered-versus-excluded split here deserves close attention before you submit another claim. If your practice bills CPT codes like 95930, 92651, 95925, or 92517, this policy change directly affects your charge capture and denial risk.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Evoked Potential Studies — CPB 0181 |
| Policy Code | CPB 0181 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Neurology, Audiology, Ophthalmology, Otolaryngology, Physical Medicine & Rehabilitation, Neurosurgery |
| Key Action | Audit your evoked potential charge capture against the covered and excluded code lists before billing any claims with dates of service on or after September 26, 2025 |
Aetna Evoked Potential Studies Coverage Criteria and Medical Necessity Requirements 2025
The Aetna evoked potential studies coverage policy splits 21 CPT codes into two groups: covered when selection criteria are met, and not covered for the indications listed in the bulletin. That second group is not gray area. Aetna is explicit—those codes are excluded.
The covered codes span four categories of evoked potential testing: auditory evoked potentials (CPT 92650, 92651, 92652, 92653), evoked otoacoustic emissions (CPT 92558, 92587, 92588), visual evoked potential testing (CPT 95930), somatosensory evoked potentials (CPT 95925, 95926, 95927, 95938), and vestibular evoked myogenic potential testing (CPT 92517, 92519). Medical necessity documentation must support the clinical indication for each test ordered.
Coverage is conditional. "Covered when selection criteria are met" means Aetna will review medical necessity on a claim-by-claim or prior authorization basis. Your documentation must connect the specific test ordered to a supported clinical indication. The 698 ICD-10-CM diagnosis codes listed under this policy give you a roadmap for which conditions Aetna recognizes as valid indications—ranging from demyelinating disease and brain tumors to metabolic disorders, infectious encephalitis, and neurodegenerative conditions.
If your team bills evoked potential studies for patients with multiple sclerosis, brain neoplasms, dementia workups, or hearing assessment in neurological disease, those clinical scenarios map directly to the covered ICD-10 categories in this policy. Pair the wrong diagnosis code with a covered CPT code and you're looking at a claim denial. Pair the right diagnosis with an excluded CPT code and you're in the same position.
Check whether your payer contracts require prior authorization for evoked potential studies. This policy bulletin sets coverage criteria, but prior auth requirements vary by plan. If you're billing Aetna commercial or Aetna Medicare Advantage plans, confirm prior authorization requirements at the plan level before scheduling.
Aetna Evoked Potential Studies Exclusions and Non-Covered Indications
Four CPT codes and two emerging procedure codes are explicitly not covered under CPB 0181. This is where billing teams lose money—either by billing excluded codes expecting payment, or by not flagging them for ABN purposes when appropriate.
CPT 92518 (ocular VEMP, oVEMP) is excluded. This matters if your audiology or ENT practice performs both cervical VEMP (CPT 92517, 92519—covered) and ocular VEMP in the same session. You can bill the cervical codes with supporting medical necessity. You cannot expect reimbursement for 92518.
Central motor evoked potential studies via transcranial motor stimulation—CPT 95928, 95929, and 95939—are not covered. These codes cover upper limb, lower limb, and combined upper-and-lower-limb central motor testing. If your neurology practice uses transcranial motor stimulation for monitoring or diagnosis, Aetna will not pay for it under this policy.
CPT 0333T, the automated visual acuity screening using visual evoked potential, is not covered for screening purposes. Standard visual evoked potential testing (CPT 95930) is covered when criteria are met—but 0333T for screening is a hard exclusion.
CPT 0858T, externally applied transcranial magnetic stimulation with concomitant measurement of evoked cortical potentials, is also not covered. This is a newer Category III code, and Aetna's exclusion signals they consider the evidence base insufficient for coverage.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT Codes | Notes |
|---|---|---|---|
| Auditory evoked potential — hearing status determination | Covered (criteria required) | 92651 | Medical necessity documentation required |
| Auditory evoked potential — threshold estimation | Covered (criteria required) | 92652 | Medical necessity documentation required |
| Auditory evoked potential — neurodiagnostic | Covered (criteria required) | 92653 | Medical necessity documentation required |
| Auditory evoked potential — screening, automated | Covered (criteria required) | 92650 | Medical necessity documentation required |
| Evoked otoacoustic emissions — screening | Covered (criteria required) | 92558 | Medical necessity documentation required |
| Evoked otoacoustic emissions — limited | Covered (criteria required) | 92587 | Medical necessity documentation required |
| Evoked otoacoustic emissions — comprehensive/diagnostic | Covered (criteria required) | 92588 | Medical necessity documentation required |
| Visual evoked potential — CNS, checkerboard or flash | Covered (criteria required) | 95930 | Medical necessity documentation required |
| Somatosensory evoked potential — upper limbs | Covered (criteria required) | 95925 | Medical necessity documentation required |
| Somatosensory evoked potential — lower limbs | Covered (criteria required) | 95926 | Medical necessity documentation required |
| Somatosensory evoked potential — trunk or head | Covered (criteria required) | 95927 | Medical necessity documentation required |
| Somatosensory evoked potential — upper and lower limbs | Covered (criteria required) | 95938 | Medical necessity documentation required |
| Cervical VEMP (cVEMP) | Covered (criteria required) | 92517, 92519 | Medical necessity documentation required |
| Ocular VEMP (oVEMP) | Not Covered | 92518 | Explicitly excluded under CPB 0181 |
| Central motor evoked potential — upper limbs (transcranial) | Not Covered | 95928 | Explicitly excluded under CPB 0181 |
| Central motor evoked potential — lower limbs (transcranial) | Not Covered | 95929 | Explicitly excluded under CPB 0181 |
| Central motor evoked potential — upper and lower limbs (transcranial) | Not Covered | 95939 | Explicitly excluded under CPB 0181 |
| Visual evoked potential — screening of visual acuity, automated | Not Covered | 0333T | Excluded for screening purposes |
| TMS with concomitant evoked cortical potential measurement | Not Covered | 0858T | Excluded; evidence considered insufficient |
| Ventriculo-peritoneal or -pleural shunt creation | Related code | 62223 | Related procedure; not standalone evoked potential study |
Aetna Evoked Potential Studies Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture before September 26, 2025. Pull every evoked potential CPT code your practice has billed in the last 12 months. Cross-reference against the covered and excluded lists in CPB 0181. If 92518, 95928, 95929, 95939, 0333T, or 0858T appear in your charge master or order sets, flag them now. |
| 2 | Update your order sets and charge description master. Remove or flag the non-covered codes—92518, 95928, 95929, 95939, 0333T, and 0858T—so providers aren't inadvertently ordering them for Aetna patients without a coverage discussion first. A clean CDM prevents downstream denial volume. |
| 3 | Pair every covered CPT code to a supported ICD-10 diagnosis. The 698 ICD-10 codes listed under CPB 0181 represent Aetna's recognized clinical indications. Before billing CPT 95930, 92651, 92653, or any other covered evoked potential code, confirm the diagnosis on the claim maps to that list. Vague or unsupported diagnoses are a straight path to a claim denial. |
| 4 | Confirm prior authorization requirements at the plan level. CPB 0181 sets the coverage policy framework, but individual Aetna plan contracts determine whether prior authorization is required before performing covered studies. Check authorization requirements for each patient's specific plan before scheduling. Call the number on the back of the card or use Aetna's provider portal. |
| 5 | Prepare ABN documentation for oVEMP (CPT 92518) patients. If your audiologists or ENT providers perform ocular VEMP testing alongside cervical VEMP, you need a process to issue Advance Beneficiary Notices (or equivalent plan-specific waiver documents) for Aetna patients. You can still bill CPT 92517 or 92519 for covered cVEMP—but 92518 requires patient financial responsibility discussion upfront. |
| 6 | Review any intraoperative or monitoring protocols using transcranial motor stimulation. CPT codes 95928, 95929, and 95939 are excluded under this coverage policy. If your neurosurgery or spine surgery team uses transcranial motor evoked potential monitoring intraoperatively, verify how those services get billed and whether alternative coding applies. Talk to your compliance officer before the September 26, 2025 effective date if your protocols use these codes regularly. |
| 7 | Don't conflate CPT 95930 with CPT 0333T. Standard VEP testing (CPT 95930) is covered when criteria are met. Automated visual acuity screening using VEP (CPT 0333T) is not covered for screening. If your practice has expanded into vision screening using newer automated technology, bill accordingly—and don't expect Aetna reimbursement for 0333T in screening contexts. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Evoked Potential Studies Under CPB 0181
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 92517 | CPT | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) |
| 92519 | CPT | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) — additional descriptor |
| 92558 | CPT | Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient) |
| 92587 | CPT | Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion product) |
| 92588 | CPT | Evoked otoacoustic emissions; comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic) |
| 92650 | CPT | Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis |
| 92651 | CPT | Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation |
| 92652 | CPT | Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report |
| 92653 | CPT | Auditory evoked potentials; neurodiagnostic, with interpretation and report |
| 95925 | CPT | Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites; upper limbs |
| 95926 | CPT | Short-latency somatosensory evoked potential study; in lower limbs |
| 95927 | CPT | Short-latency somatosensory evoked potential study; in the trunk or head |
| 95930 | CPT | Visual evoked potential (VEP) testing central nervous system, checkerboard or flash |
| 95938 | CPT | Short-latency somatosensory evoked potential study; in upper and lower limbs |
Not Covered / Excluded Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 92518 | CPT | Vestibular evoked myogenic potential (VEMP) testing; ocular (oVEMP) | Not covered for indications listed in CPB 0181 |
| 95928 | CPT | Central motor evoked potential study (transcranial motor stimulation); upper limbs | Not covered for indications listed in CPB 0181 |
| 95929 | CPT | Central motor evoked potential study (transcranial motor stimulation); lower limbs | Not covered for indications listed in CPB 0181 |
| 95939 | CPT | Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs | Not covered for indications listed in CPB 0181 |
| 0333T | CPT | Visual evoked potential, screening of visual acuity, automated | Not covered for screening purposes |
| 0858T | CPT | Externally applied transcranial magnetic stimulation with concomitant measurement of evoked cortical potentials | Not covered for indications listed in CPB 0181 |
Key ICD-10-CM Diagnosis Codes (Selected from 698 Total)
The full code set under CPB 0181 includes 698 ICD-10-CM codes. Below is a representative selection across the major diagnostic categories. Pull the full list from the policy source to build your billing guidelines reference.
| Code | Description |
|---|---|
| A39.82 | Meningococcal retrobulbar neuritis |
| A52.10–A52.19 | Symptomatic neurosyphilis |
| A69.20 | Lyme disease, unspecified |
| A81.2 | Progressive multifocal leukoencephalopathy |
| A83.0–A84.9 | Mosquito-borne and tick-borne viral encephalitis |
| A85.2 | Viral encephalitis transmitted by other means |
| B00.4 | Herpesviral encephalitis |
| B05.0 | Measles complicated by encephalitis |
| B06.01 | Rubella encephalitis |
| B10.01 | Human herpesvirus 6 encephalitis |
| B10.09 | Other human herpesvirus encephalitis |
| C71.0–C71.9 | Malignant neoplasm of brain |
| C79.31 | Secondary malignant neoplasm of brain and spinal cord |
| C79.49 | Secondary malignant neoplasm of other nervous system parts |
| D32.0–D33.9 | Benign neoplasm of brain and other parts of nervous system |
| D42.0–D43.9 | Neoplasm of uncertain behavior of brain, spinal cord, and meninges |
| D49.6 | Neoplasm of unspecified behavior of brain |
| E22.0–E23.7 | Hyperfunction, hypofunction, and other disorders of pituitary gland |
| E83.01 | Wilson's disease |
| E70.0–E89.89 | Metabolic disorders |
| F01.50–F03.91 | Dementia and delirium |
| F05 | Delirium due to known physiological condition |
| F10.27 | Alcohol dependence with alcohol-induced persisting dementia |
| F11.22–F11.224 | Drug-induced persisting dementia |
The remaining 618+ ICD-10 codes span infectious diseases, metabolic disorders, neoplasms, demyelinating conditions, neurodegenerative diseases, and structural neurological diagnoses. Access the complete list at the CPB 0181 Aetna policy source and load it into your billing guidelines reference for evoked potential studies.
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