Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) of the Spine — CPB 0236 | AETNA Coverage Update

Aetna modified CPB 0236 governing spine MRI and CT coverage, effective September 26, 2025. Here's what billing teams need to act on before claims start denying.

Aetna, a CVS Health company, updated its spine imaging coverage policy under CPB 0236 in the Aetna MRI and CT spine coverage policy. This revision affects 18 covered CPT codes—including 72141 through 72158 for spinal MRI and 72125 through 72133 for spinal CT—plus seven HCPCS contrast agent codes. If your practice bills spine imaging to Aetna members, review your documentation protocols against the updated criteria now.

Quick-Reference Table

Aetna Spine MRI and CT Coverage Criteria and Medical Necessity Requirements 2025

The real issue with the CPB 0236 Aetna system update is the specificity of the medical necessity criteria. Aetna covers spine MRI and CT when a patient meets any one of 18 distinct clinical indications. That "any one" threshold sounds permissive—but each criterion carries documentation requirements your providers must satisfy before you bill.

Here is what Aetna's updated coverage policy requires. The patient's record must show clinical evidence of at least one of the following:

Two criteria carry explicit conservative therapy timelines. "Conservative therapy" is defined by the policy as moderate activity, analgesics, NSAIDs, and muscle relaxants. Document all four components—not just one. If your provider only documented NSAIDs and the patient failed to return for six weeks, that's not sufficient. The record must reflect the full conservative therapy protocol.

This is where claim denial risk concentrates. Radiculopathy claims billing CPT 72148 or 72158 for lumbar MRI are the most commonly denied spine imaging claims. The culprit is almost always a missing timeline or incomplete documentation of objective neurological findings.

Spine MRI and CT billing reimbursement depends entirely on the strength of the clinical record attached to these codes. Aetna's prior authorization process will scrutinize exactly these criteria. If prior authorization is required for your patient's plan, submit documentation that maps directly to one of the 18 indications above—by name, not just by diagnosis code.

Aetna Spine Imaging Exclusions and Non-Covered Indications

One code in this policy is explicitly not covered for any indication listed in CPB 0236: G0566, the algorithm-derived 3D radiodensity-value bone imaging code from prior MRI examination data.

Do not bill G0566 under this policy. It appears in the code table specifically as excluded. If your radiology or AI-assisted imaging workflow generates this code in the context of spine studies, pull it from your charge capture for Aetna claims.

CPT 76390 (magnetic resonance spectroscopy) also appears in the policy as a related code but sits outside the covered/not-covered designation. It is listed for reference only. Do not assume it carries the same coverage status as the primary spine MRI codes.

Coverage Indications at a Glance

Aetna Spine MRI and CT Billing Guidelines and Action Items 2025

Spine MRI and CT billing under the updated CPB 0236 Aetna policy requires specific process changes before the September 26, 2025 effective date. Here is what your team needs to do now.

1. Pull G0566 from your Aetna charge capture immediately.
This code is explicitly not covered under CPB 0236. Any automated charge capture that appends G0566 to spine imaging workflows will generate denials. Remove it from Aetna-specific charge master entries before September 26, 2025.

2. Build the six-week and four-week timelines into your prior auth intake forms.
For radiculopathy cases (CPT 72148, 72158, 72141), the record must show failed conservative therapy over six weeks. For spondylolisthesis and degenerative disease, the threshold is four weeks. If your intake form does not prompt for this timeline, update it. Reviewers at Aetna will look for these dates when processing prior authorization requests.

3. Update documentation templates to capture all four conservative therapy components.
"Conservative therapy" under this policy means moderate activity, analgesics, NSAIDs, and muscle relaxants. A template that only captures "conservative treatment" as a checkbox does not support the claim. Physicians need to document which components were tried and for how long.

4. Verify contrast agent billing codes against the approved HCPCS list.
Aetna covers seven HCPCS contrast agents under this policy: A9575, A9576, A9577, A9578, A9579, Q9953, and Q9954. Cross-check your contrast agent charge codes against this list. If you use a contrast agent not on this list, expect a denial. Check your charge master now.

5. For pre-epidural injection imaging, document both the indication and the injection plan.
CPT 72148 or 72141 billed before an epidural injection requires documentation of two things: the reason for imaging (ruling out tumor or infection) and the goal of delineating the optimal injection site. Half-complete documentation will not support medical necessity.

6. Flag suspected infectious or malignant spine cases for expedited authorization.
Osteomyelitis, epidural abscess, spinal metastases, and primary spinal cord tumors all qualify for coverage. These cases often have urgent timelines. Know your Aetna contacts for expedited prior auth so you are not waiting 72 hours when the patient is admitted.

7. If your billing volume for spine imaging is high, loop in your compliance officer.
The criteria update touches 18 clinical indications and 543 ICD-10 codes. If spine imaging is a significant revenue line for your practice or health system, have your compliance officer review your documentation policies against the updated CPB 0236 criteria before the effective date of September 26, 2025.

CPT, HCPCS, and ICD-10 Codes for Spine MRI and CT Under CPB 0236

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered / Excluded Codes

Covered HCPCS Contrast Agent Codes (When Selection Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

The full policy includes 543 ICD-10-CM codes. Below are the highest-volume and highest-risk diagnosis categories your billing team should map to spine imaging claims.

The ICD-10 list skews heavily toward oncology because metastatic workup and primary spine tumor evaluation are two of the strongest coverage indications in this policy. Map your diagnosis codes carefully. A patient with a known primary malignancy and new back pain should carry both the primary cancer code and the appropriate spine symptom code.