TL;DR: Aetna, a CVS Health company, modified CPB 0238 governing chronic vertigo coverage, effective September 26, 2025. Here's what changes for billing teams.
This update to the Aetna chronic vertigo coverage policy touches 18 covered CPT codes, four non-covered CPT codes, and three HCPCS codes — including vestibular testing, canalith repositioning (CPT 95992), and vestibular rehabilitation (HCPCS S9476). If your practice bills for vestibular function testing or rehabilitative services under Aetna, this policy directly affects your reimbursement and claim denial exposure. Review your charge capture against the updated CPB 0238 Aetna criteria before billing any chronic vertigo workup.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Chronic Vertigo — CPB 0238 |
| Policy Code | CPB 0238 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium |
| Specialties Affected | Audiology, Neurology, ENT/Otolaryngology, Physical Therapy, Vestibular Rehabilitation |
| Key Action | Audit your charge capture for CPT 92517–92547, 95992, and HCPCS S9476 against the updated selection criteria before submitting Aetna claims |
Aetna Chronic Vertigo Coverage Criteria and Medical Necessity Requirements 2025
CPB 0238 defines which vestibular diagnostic and treatment services Aetna considers medically necessary for patients with chronic vertigo. The policy covers a range of tests — from basic spontaneous nystagmus testing (CPT 92531) to sinusoidal vertical axis rotational testing (CPT 92546) — when specific selection criteria are met.
The core covered services fall into three categories: vestibular function testing, canalith repositioning procedures, and vestibular rehabilitation. Each requires documentation that ties the service to a qualifying diagnosis. Aetna will not pay for these services on general dizziness workups that lack a confirmed vestibular etiology.
Vestibular Evoked Myogenic Potential (VEMP) Testing
Aetna covers cervical VEMP (cVEMP, CPT 92517 and 92519) and ocular VEMP (oVEMP, CPT 92518) when selection criteria are met. These codes are commonly used in diagnosing superior semicircular canal dehiscence and Ménière's disease. If you bill these, your documentation must support the specific vestibular disorder being evaluated — a generic "dizziness" note will not hold up.
Electronystagmography and Rotational Testing
The ENG/VNG battery is covered under this coverage policy. That includes spontaneous nystagmus with recording (CPT 92541), positional nystagmus test with recording (CPT 92542), caloric vestibular testing with bilateral bithermal recording (CPT 92537), and optokinetic nystagmus testing with recording (CPT 92544). The oscillating tracking test (CPT 92545), sinusoidal vertical axis rotational testing (CPT 92546), and use of vertical electrodes billed as an add-on (CPT +92547) are also covered when criteria are satisfied.
Canalith Repositioning and Rehabilitation
CPT 95992 — the Epley maneuver, Semont maneuver, and similar canalith repositioning procedures — is covered per day when medical necessity is established. Vestibular rehabilitation billed under HCPCS S9476 (non-physician provider, per diem) is also covered when criteria are met. This is significant for practices using physical therapists or audiologists to deliver vestibular rehab. Neuromuscular re-education (CPT 97112) appears in the policy as a related code but is not explicitly grouped as covered or excluded — treat it as a flag for your billing guidelines review.
Prior Authorization
The policy does not list specific prior authorization thresholds within the CPB text, but Aetna routinely applies prior auth requirements at the plan level for vestibular testing batteries. Check the member's specific plan before submitting multi-code vestibular testing claims. A prior authorization denial on a covered service is still a claim denial — and it's avoidable.
Aetna Chronic Vertigo Exclusions and Non-Covered Indications
Four CPT codes and two HCPCS codes are explicitly non-covered under this policy. This is where claim denial risk concentrates.
Computerized Dynamic Posturography (CDP)
Aetna does not cover CPT 92548 (computerized dynamic posturography sensory organization test, CDP-SOT, six conditions) or CPT 92549 (CDP-SOT with motor control test and adaptation test). These are commonly billed by balance centers and vestibular rehab practices. If you've been billing CDP under Aetna for chronic vertigo, stop now. The effective date is September 26, 2025 — any claim with a service date on or after that date is at risk.
Auditory Evoked Potentials
CPT 92650 (broadband stimuli screening, automated), CPT 92651 (hearing status determination), CPT 92652 (threshold estimation), and CPT 92653 (neurodiagnostic, with interpretation) are all non-covered for chronic vertigo indications listed in CPB 0238. These codes are appropriate in audiological workups, but Aetna draws a clear line: auditory evoked potentials are outside this coverage policy for chronic vertigo.
Equipment: Pulse Generator Systems
HCPCS E2120 (pulse generator system for tympanic treatment of inner ear endolymphatic fluid) and HCPCS A4638 (replacement battery for patient-owned ear pulse generator) are not covered. If your practice has been supplying or billing for these devices under Aetna, expect denials. These are considered outside the covered treatment modalities for chronic vertigo under CPB 0238.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Vestibular evoked myogenic potential testing (cVEMP, oVEMP) | Covered | CPT 92517, 92518, 92519 | Selection criteria must be met |
| Spontaneous nystagmus testing (without recording) | Covered | CPT 92531 | Selection criteria must be met |
| Positional nystagmus test / Hallpike maneuver (without recording) | Covered | CPT 92532 | Selection criteria must be met |
| Caloric vestibular test, each irrigation | Covered | CPT 92533 | Selection criteria must be met |
| Optokinetic nystagmus test (without recording) | Covered | CPT 92534 | Selection criteria must be met |
| Caloric vestibular test with recording, bilateral bithermal | Covered | CPT 92537 | Selection criteria must be met |
| Caloric vestibular test with recording, monothermal | Covered | CPT 92538 | Selection criteria must be met |
| Spontaneous nystagmus test with recording | Covered | CPT 92541 | Selection criteria must be met |
| Positional nystagmus test (min. 4 positions) with recording | Covered | CPT 92542 | Selection criteria must be met |
| Vestibular function tests with recording (e.g., ENG) | Covered | CPT 92543 | Selection criteria must be met |
| Optokinetic nystagmus test with recording | Covered | CPT 92544 | Selection criteria must be met |
| Oscillating tracking test with recording | Covered | CPT 92545 | Selection criteria must be met |
| Sinusoidal vertical axis rotational testing | Covered | CPT 92546 | Selection criteria must be met |
| Vertical electrodes (add-on) | Covered | CPT +92547 | List separately with primary procedure |
| Canalith repositioning (Epley, Semont maneuver) | Covered | CPT 95992 | Per day; medical necessity required |
| Dynamic acuity testing | Covered | CPT 99173 | Selection criteria must be met |
| Vestibular rehabilitation, non-physician provider | Covered | HCPCS S9476 | Per diem; selection criteria must be met |
| Computerized dynamic posturography (CDP-SOT) | Not Covered | CPT 92548 | Excluded under CPB 0238 |
| CDP-SOT with motor control and adaptation testing | Not Covered | CPT 92549 | Excluded under CPB 0238 |
| Auditory evoked potentials — screening | Not Covered | CPT 92650 | Not covered for chronic vertigo |
| Auditory evoked potentials — hearing status | Not Covered | CPT 92651 | Not covered for chronic vertigo |
| Auditory evoked potentials — threshold estimation | Not Covered | CPT 92652 | Not covered for chronic vertigo |
| Auditory evoked potentials — neurodiagnostic | Not Covered | CPT 92653 | Not covered for chronic vertigo |
| Pulse generator system for tympanic treatment | Not Covered | HCPCS E2120 | Device excluded under CPB 0238 |
| Replacement battery for ear pulse generator | Not Covered | HCPCS A4638 | Device excluded under CPB 0238 |
Aetna Chronic Vertigo Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 92548 and 92549 immediately. If your balance center or vestibular rehab program has been billing computerized dynamic posturography under Aetna, you need to pull those charges before any claims with a service date of September 26, 2025 or later go out the door. These are now explicitly non-covered. Any claim that goes out will deny. |
| 2 | Remove CPT 92650–92653 from your chronic vertigo order sets for Aetna patients. Auditory evoked potentials have no reimbursement pathway under CPB 0238 for chronic vertigo indications. If a clinician orders these alongside a vestibular battery, your billing team needs to flag them before submission — not after the denial. |
| 3 | Confirm HCPCS S9476 documentation supports the per-diem structure. Vestibular rehabilitation billed under S9476 is covered, but the per-diem billing structure requires clear date-specific documentation. Each day of service needs its own supporting note. A bundled or undated progress note is a denial waiting to happen. |
| 4 | Verify plan-level prior authorization requirements before billing multi-code vestibular testing batteries. Aetna's CPB sets coverage policy, but individual plan documents control prior auth thresholds. A five-code ENG battery for a commercial HMO patient may need prior auth even if the CPB covers each code. Check eligibility and benefits before the appointment, not after. |
| 5 | Update your ICD-10 linkage on chronic vertigo claims. This policy supports 174 ICD-10-CM codes — including H81.01–H83.93 (disorders of vestibular function), H81.10–H81.13 (benign paroxysmal vertigo), G43 series (vertiginous migraine), F45 series (persistent postural perceptual dizziness/PPPD), and G35 (multiple sclerosis). Your diagnosis codes must map precisely to the tested condition. A mismatch between the vestibular test ordered and the ICD-10 on the claim is one of the most common denial patterns in chronic vertigo billing. |
| 6 | Flag E2120 and A4638 in your DME billing workflow. If your practice supplies or bills for the pulse generator system or replacement batteries, remove Aetna from your payer mix for these items. They are not covered under this policy, and there is no appeals pathway for services explicitly excluded by the CPB. |
If you're running a high-volume vestibular program and your Aetna mix is significant, talk to your compliance officer before the effective date. The CDP exclusion alone — CPT 92548 and 92549 — could represent material revenue exposure depending on your payer mix.
| 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 Chronic Vertigo Under CPB 0238
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| 92517 | Vestibular evoked myogenic potential (VEMP) testing; cervical (cVEMP), with interpretation and report |
| 92518 | Vestibular evoked myogenic potential (VEMP) testing; ocular (oVEMP), with interpretation and report |
| 92519 | Vestibular evoked myogenic potential (VEMP) testing; cervical (cVEMP), with interpretation and report |
| 92531 | Spontaneous nystagmus, including gaze |
| 92532 | Positional nystagmus test (Hallpike maneuver) |
| 92533 | Caloric vestibular test, each irrigation |
| 92534 | Optokinetic nystagmus test |
| 92537 | Caloric vestibular test with recording, bilateral bithermal |
| 92538 | Caloric vestibular test with recording, monothermal |
| 92541 | Spontaneous nystagmus test with recording, including gaze and fixation nystagmus |
| 92542 | Positional nystagmus test, minimum of 4 positions, with recording |
| 92543 | Vestibular function tests with recording (e.g., ENG) |
| 92544 | Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording |
| 92545 | Oscillating tracking test, with recording |
| 92546 | Sinusoidal vertical axis rotational testing |
| +92547 | Use of vertical electrodes (add-on; list separately with primary procedure) |
| 95992 | Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day |
| 99173 | Screening test of visual acuity, quantitative, bilateral (dynamic acuity testing) |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| S9476 | Vestibular rehabilitation program, non-physician provider, per diem |
Not Covered CPT Codes
| Code | Description | Reason |
|---|---|---|
| 92548 | Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions | Not covered for indications listed in CPB 0238 |
| 92549 | CDP-SOT with motor control test (MCT) and adaptation test (ADT) | Not covered for indications listed in CPB 0238 |
| 92650 | Auditory evoked potentials; screening, broadband stimuli, automated analysis | Not covered for indications listed in CPB 0238 |
| 92651 | Auditory evoked potentials; hearing status determination, broadband stimuli, with interpretation | Not covered for indications listed in CPB 0238 |
| 92652 | Auditory evoked potentials; threshold estimation at multiple frequencies, with interpretation | Not covered for indications listed in CPB 0238 |
| 92653 | Auditory evoked potentials; neurodiagnostic, with interpretation and report | Not covered for indications listed in CPB 0238 |
Not Covered HCPCS Codes
| Code | Description | Reason |
|---|---|---|
| E2120 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid | Not covered for indications listed in CPB 0238 |
| A4638 | Replacement battery for patient-owned ear pulse generator, each | Not covered for indications listed in CPB 0238 |
Related CPT Code
| Code | Description | Notes |
|---|---|---|
| 97112 | Neuromuscular re-education of movement, balance, coordination — per 15 minutes | Related code; review against active plan benefits |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| H81.01–H83.93 | Disorders of vestibular function (full range) |
| H81.10–H81.13 | Benign paroxysmal vertigo, unspecified/right/left/bilateral ear |
| H81.14–H81.18 | Additional disorders of vestibular function |
| G43.001–G43.919 | Migraine, including vertiginous migraine |
| G43.001–G43.919 | Migraine (vertiginous) |
| F45.0, F45.1, F45.8, F45.9 | Somatoform disorder (persistent postural perceptual dizziness / PPPD) |
| G35 | Multiple sclerosis |
| G40.001–G40.219 | Epilepsy and recurrent seizures (temporal lobe epilepsy) |
| G93.5 | Compression of brain |
| C71.6 | Malignant neoplasm of cerebellum |
| C79.31–C79.49 | Secondary malignant neoplasm of brain/nervous system (cerebellopontine angle) |
| D21.0 | Benign neoplasm of connective and soft tissue of head, face, neck (cerebellopontine angle tumor) |
| D32.0 | Benign neoplasm of cerebral meninges (cerebellopontine angle tumor) |
| D33.3 | Benign neoplasm of cranial nerves (cerebellopontine angle tumor) |
| D43.0–D43.9 | Neoplasm of uncertain behavior of brain and CNS (cerebellopontine angle tumor) |
The full ICD-10-CM list for CPB 0238 includes 174 codes. The table above captures the primary diagnostic groupings. Review the full code list at the Aetna CPB 0238 source before building your claim templates.
Get the Full Picture for CPT 95992
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.