Hemodialysis for Schizophrenia — CPB 0291 | AETNA Coverage Update

Aetna updated CPB 0291 on January 31, 2026, classifying hemodialysis for schizophrenia as experimental, investigational, or unproven — meaning CPT codes 90935, 90937, and 90940 will not be reimbursed when billed against psychiatric diagnoses under F20.x or F25.x. Here's what billing teams need to know.

Aetna, a CVS Health company, modified its hemodialysis coverage policy under CPB 0291 in the Aetna system. The change draws a hard line: dialysis procedures billed for schizophrenia or schizoaffective disorder diagnoses are not covered. If your revenue cycle team handles any behavioral health or nephrology crossover billing — or if you're at a facility where both dialysis and psychiatric diagnoses coexist on claims — this policy update deserves your attention now.

Quick-Reference Table

Aetna Hemodialysis Coverage Criteria and Medical Necessity Requirements 2026

The Aetna hemodialysis coverage policy under CPB 0291 is narrow and direct. Aetna does not recognize hemodialysis as a medically necessary treatment for schizophrenia or schizoaffective disorders.

The policy states that hemodialysis for schizophrenia has not been demonstrated or established as effective. That language is Aetna's standard framing for experimental, investigational, or unproven services — and it carries real financial consequences.

Hemodialysis billing under CPT 90935 (single physician evaluation), CPT 90937 (repeated evaluations), or CPT 90940 (access flow study) is not covered when the primary or driving diagnosis is a psychiatric condition coded under F20.x or F25.x. The coverage policy excludes the indication entirely. Medical necessity cannot be established for a non-covered indication, regardless of documentation strength.

This is a rare but real claim denial risk. It typically surfaces in two scenarios: inpatient psychiatric units where a patient also has renal failure, and claims where a coder links dialysis access codes to behavioral health diagnoses by accident. Either way, the denial sticks.

Aetna Hemodialysis Exclusions and Non-Covered Indications

This is where CPB 0291 does all its work. The entire policy is an exclusion.

Aetna classifies hemodialysis for schizophrenia as experimental, investigational, or unproven. That classification applies across all schizophrenia subtypes coded F20.0 through F20.9, and all schizoaffective disorder variants coded F25.0 through F25.9.

The real issue here isn't a gray area — it's a blunt non-coverage determination. There is no clinical criteria pathway that makes this covered. There are no exceptions listed for severity, treatment-resistant cases, or co-occurring medical conditions. If the indication is psychiatric and the procedure is hemodialysis, Aetna won't pay.

Some billing teams assume that if a patient legitimately needs dialysis and happens to have schizophrenia, the psychiatric diagnosis shouldn't matter. That's correct — but only if the dialysis is coded against the renal diagnosis, not the psychiatric one. The coverage policy targets the pairing of dialysis procedure codes with psychiatric primary diagnoses. Code it correctly and you have no problem. Code it wrong and you're looking at a denial with no appeal path on medical necessity grounds.

Coverage Indications at a Glance

Aetna Hemodialysis Billing Guidelines and Action Items 2026

CPT, HCPCS, and ICD-10 Codes for Hemodialysis Under CPB 0291

Not Covered CPT Codes — Hemodialysis for Schizophrenia

These three CPT codes are explicitly listed as not covered for the indications in CPB 0291.

Key ICD-10-CM Diagnosis Codes Referenced in CPB 0291

These are the diagnosis codes Aetna identifies in the context of this coverage policy. The F20 and F25 codes are the psychiatric diagnoses that trigger non-coverage. The Z49 and Z99 codes reflect legitimate dialysis encounter and dependency coding — relevant for ensuring correct primary diagnosis selection on claims for patients with co-occurring renal disease.

Schizophrenia (F20.x)

Schizoaffective Disorders (F25.x)

Renal Dialysis Encounter and Dependency Codes (Z49.x, Z99.2)