Liver and Other Neoplasms - Treatment Approaches — CPB 0268 | AETNA Coverage Update

Aetna modified CPB 0268 for liver and other neoplasm treatment approaches, effective September 26, 2025. Here's what billing teams need to know.

Aetna, a CVS Health company, updated its liver and other neoplasms coverage policy under CPB 0268 Aetna system, affecting 18 CPT codes and nine HCPCS codes tied to interventional oncology procedures. The update spans hepatic arterial infusion, radioembolization with yttrium-90, surgical hepatectomy, and several explicitly non-covered technologies — including the TriNav Infusion System. If your practice bills 37243, C2616, S2095, or any of the hepatectomy codes (47120–47130), this policy change deserves your attention before September 26, 2025.

Quick-Reference Table

Aetna Liver Neoplasm Treatment Coverage Criteria and Medical Necessity Requirements 2025

The Aetna liver and other neoplasms coverage policy under CPB 0268 draws a hard line between procedures covered when medical necessity criteria are met and those it won't pay for under any indication listed in this bulletin.

For covered procedures, selection criteria matter enormously. Hepatocellular carcinoma (HCC) without extrahepatic spread — coded C22.0 — is the anchor diagnosis for many of the interventional procedures in this policy. Yttrium-90 radioembolization billed via C2616, Q3001, or S2095, and transcatheter embolization via 37242 and 75894 (with caveats), fall under the covered umbrella when the patient and clinical situation meet Aetna's criteria. Prior authorization is standard for these procedures — don't submit without it.

Intra-arterial chemotherapy codes 96420, 96422, 96423, and 96425 are listed as related codes, but the policy explicitly states these are not covered for liver metastases from breast or colorectal cancer. That's a denial risk hiding in plain sight if your team doesn't link the diagnosis correctly.

Hepatic resection — CPT codes 47120 (partial lobectomy), 47122 (trisegmentectomy), 47125 (total left lobectomy), and 47130 (total right lobectomy) — is covered for appropriate hepatic malignancies. But C22.1 through C22.8 (intrahepatic bile duct and liver malignancies marked as unresectable) carry an explicit exclusion from hepatectomy coverage. Billing a resection code against an unresectable diagnosis code is a fast path to claim denial.

For implantable arterial infusion pumps — CPT 36260 and maintenance code 96522 — the medical necessity bar is high. These are covered when selection criteria are met, but Aetna scrutinizes these claims closely. Document the clinical rationale thoroughly before submitting.

Pancreatic endocrine tumors involving the liver (C25.0–C25.9) are covered for interventional procedures only in patients who have failed systemic therapy. If your documentation doesn't reflect prior systemic treatment failure, don't expect reimbursement on those claims.

Aetna Liver Neoplasm Treatment Exclusions and Non-Covered Indications

Three HCPCS codes are explicitly not covered for any indication listed in this policy. That's an unusual level of specificity from Aetna, and it signals active denial enforcement.

C1982, C8004, and C9797 all relate to the TriNav Infusion System — a pressure-generating, one-way valve catheter used in hepatic arterial delivery. Aetna considers this technology experimental and will not cover it. CPT 37243 and 75894 carry the same exclusion when billed in the context of the TriNav system. If you're at a facility using TriNav, flag this immediately with your interventional radiology billing team.

E0767 — the intrabuccal radiofrequency electromagnetic field device — is also not covered under this policy. This exclusion applies to the amplitude-modulated, radiofrequency electromagnetic field delivery system marketed for tumor-related indications.

Electro-chemotherapy and immunotherapy with dendritic cells fall in a separate excluded category. CPT 79445 (radiopharmaceutical therapy by intra-arterial particulate administration) appears in that exclusion group, which is counterintuitive given that yttrium-90 radioembolization codes are covered. The difference lies in the specific delivery method and billing vehicle — 79445 is not the right code for Y-90 microspheres. Use C2616 and S2095 for yttrium-90 radioembolization.

Colorectal cancer liver metastases (C18.0–C21.8) are explicitly excluded from "one-shot" arterial infusion. Document your infusion approach carefully if treating patients with this diagnosis.

Coverage Indications at a Glance

Aetna Liver Neoplasm Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Liver Neoplasm Treatment Under CPB 0268

Covered CPT Codes (When Selection Criteria Are Met)

Covered HCPCS Codes (When Selection Criteria Are Met)

Not Covered / Experimental Codes

Key ICD-10-CM Diagnosis Codes

The full ICD-10-CM code list under CPB 0268 contains 207 codes. The table above covers the primary diagnosis groupings. Confirm the complete list in the policy document before submitting claims.