Aetna modified CPB 0357 for quantitative sensory testing (QST), effective September 26, 2025. Here's what billing teams need to do.
Aetna, a CVS Health company, updated its coverage policy under CPB 0357 in the Aetna quantitative sensory testing coverage policy. This policy classifies CPT codes 0106T through 0110T — the entire QST code series — as not covered, along with HCPCS code G0255 for current perception threshold testing. If your practice bills for nerve sensation testing in neurology, pain management, or endocrinology, this update demands your attention before claims go out the door.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Quantitative Sensory Testing Methods |
| Policy Code | CPB 0357 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Neurology, pain management, endocrinology, physical medicine & rehabilitation, oncology |
| Key Action | Remove CPT 0106T–0110T and HCPCS G0255 from Aetna charge capture and redirect to covered alternatives where appropriate |
Aetna Quantitative Sensory Testing Coverage Criteria and Medical Necessity Requirements 2025
The core message of this coverage policy is simple: Aetna does not cover quantitative sensory testing. Full stop.
CPT codes 0106T, 0107T, 0108T, 0109T, and 0110T all fall under the "not covered for indications listed in the CPB" classification. This applies regardless of the clinical indication. Whether your provider is assessing touch pressure sensation (0106T), vibration stimuli for large-diameter fiber sensation (0107T), cooling stimuli for small fiber neuropathy (0108T), heat-pain stimuli (0109T), or any other sensory stimulus (0110T), Aetna will not reimburse the claim.
HCPCS G0255, the current perception threshold/sensory nerve conduction test per limb, carries the same non-covered designation. This code is used across many neurology and pain practices for lower-extremity peripheral neuropathy workups. If your billing team has been treating G0255 as a covered service under Aetna contracts, that's a claim denial waiting to happen.
Medical necessity is not the issue here — coverage is. Even with a textbook-appropriate diagnosis like diabetic peripheral neuropathy (E10.40–E10.49, E11.40–E11.49) or small fiber neuropathy (G62.89), Aetna's position is that QST methods are experimental or investigational. No prior authorization pathway unlocks these codes. Prior authorization is irrelevant when the procedure isn't covered at all.
The real issue is that many billing teams conflate "related codes are covered" with "the procedure is covered." Nerve conduction studies — CPT 95907 through 95913 — and somatosensory evoked potentials — CPT 95925, 95926, 95927 — are listed as related codes in this CPB. Related doesn't mean covered. It means Aetna recognizes these as the standard-of-care alternatives.
Aetna Quantitative Sensory Testing Exclusions and Non-Covered Indications
This is where the policy data tells a stark story. The ICD-10 list attached to this CPB spans 91 diagnosis codes. It includes diabetic neuropathy, small fiber neuropathy (G62.89), POEMS syndrome (G62.9, D47.Z9), restless legs syndrome (G25.81), chronic pain syndromes (G89.21–G89.29), post-stroke central pain (G89.0), postural orthostatic tachycardia (I49.8), breast cancer (C50.011–C50.919), leprosy (A30.0–A30.9), chronic pruritus (L29.0–L29.9), myositis (M60.10–M60.15), and a range of musculoskeletal pain diagnoses.
That's a wide net. All of them are listed as conditions for which QST is not covered. Aetna's position is that for none of these indications does QST meet their medical necessity or clinical validity standard.
This matters because several of these diagnoses — diabetic neuropathy in particular — are exactly the conditions where QST gets ordered most often. Your endocrinology and neurology providers may believe QST adds diagnostic value. Aetna disagrees. Don't expect that clinical argument to move a denied claim.
Small fiber neuropathy (G62.89) is worth flagging separately. QST is sometimes used in small fiber workups when skin punch biopsy isn't available or the provider wants additional functional data. Under this coverage policy, that rationale doesn't matter for Aetna. The code still won't pay.
Coverage Indications at a Glance
| Indication | Coverage Status | Relevant Codes | Notes |
|---|---|---|---|
| Diabetic peripheral neuropathy | Not Covered | E10.40–E10.49, E11.40–E11.49 / CPT 0106T–0110T, G0255 | Covered alternatives: NCS (95907–95913) |
| Small fiber neuropathy | Not Covered | G62.89 / CPT 0106T–0110T, G0255 | No QST pathway under Aetna |
| POEMS syndrome | Not Covered | G62.9, D47.Z9 / CPT 0106T–0110T | Use NCS or SSEP coding |
| Chronic pain syndromes | Not Covered | G89.21–G89.29 / CPT 0106T–0110T | No covered QST indication |
| Post-stroke central pain | Not Covered | G89.0 / CPT 0106T–0110T | — |
| Restless legs syndrome | Not Covered | G25.81 / CPT 0106T–0110T | — |
| Nerve, root, and plexus disorders | Not Covered | G50.0–G59 / CPT 0106T–0110T, G0255 | Redirect to NCS where clinically appropriate |
| Breast cancer / oncology | Not Covered | C50.011–C50.919 / CPT 0106T–0110T | No chemotherapy-induced neuropathy exception |
| Postural orthostatic tachycardia | Not Covered | I49.8 / CPT 0106T–0110T | Autonomic testing may require different approach |
| Current perception threshold testing | Not Covered | G0255 | Applies per limb, any nerve |
| Nerve conduction studies | Related / Covered (when medically necessary) | 95907–95913 | Standard alternative to QST |
| Somatosensory evoked potentials | Related / Covered (when medically necessary) | 95925, 95926, 95927 | Standard alternative to QST |
Aetna Quantitative Sensory Testing Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Remove CPT 0106T–0110T and HCPCS G0255 from your Aetna fee schedule and charge capture before September 26, 2025. The effective date is firm. Any claim with these codes submitted against an Aetna plan on or after that date should be expected to deny. Don't wait for a remittance to confirm it. |
| 2 | Audit open authorizations and pending orders for QST. If your team has submitted prior authorization requests for any of these codes under Aetna, pull them. Prior authorization doesn't exist for non-covered services. Any approval you received under a prior policy version may not carry forward. |
| 3 | Redirect clinical workflows to covered alternatives. For diabetic neuropathy and peripheral nerve workups, nerve conduction studies (CPT 95907–95913) are the covered standard. For central and peripheral pathway assessment, somatosensory evoked potentials (CPT 95925–95927) may apply. Work with your ordering providers to understand which alternative fits the clinical situation. |
| 4 | Update your payer-specific order sets and requisition templates. If QST appears as an option in your EMR order panels for Aetna patients, remove it or flag it as non-covered. Providers ordering QST without knowing coverage status creates downstream billing problems and unhappy patients getting unexpected bills. |
| 5 | Review any claims billed in the 90 days before September 26, 2025. Check whether these QST codes were submitted and paid under a prior policy interpretation. If Aetna begins clawbacks or audits based on the policy update, you want to know your exposure before they contact you. If you have significant volume here, talk to your compliance officer before the effective date. |
| 6 | Document patient financial counseling for any QST that will proceed regardless of coverage. Some providers may continue ordering QST as a patient-pay service. If that's the case, your team needs a signed advance beneficiary notice equivalent (an ABN for non-Medicare plans, or a similar financial responsibility waiver), and it needs to happen before the service. |
| 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 Quantitative Sensory Testing Under CPB 0357
Not Covered CPT Codes (All QST Codes)
| Code | Type | Description |
|---|---|---|
| 0106T | CPT | Quantitative sensory testing (QST), testing and interpretation per extremity; using touch pressure stimuli to assess large and small nerve fiber function |
| 0107T | CPT | QST; using vibration stimuli to assess large diameter fiber sensation |
| 0108T | CPT | QST; using cooling stimuli to assess small nerve fiber sensation and hyperalgesia |
| 0109T | CPT | QST; using heat-pain stimuli to assess small nerve fiber sensation and hyperalgesia |
| 0110T | CPT | QST; using other stimuli to assess sensation |
Not Covered HCPCS Code
| Code | Type | Description |
|---|---|---|
| G0255 | HCPCS | Current perception threshold/sensory nerve conduction test (SNCT), per limb, any nerve |
Key ICD-10-CM Diagnosis Codes Referenced in CPB 0357
| Code | Description |
|---|---|
| A30.0–A30.9 | Leprosy (Hansen's disease), various types |
| C50.011–C50.919 | Malignant neoplasm of breast |
| D47.Z9 | Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue (POEMS syndrome) |
| E10.40–E10.49 | Type 1 diabetes with diabetic neurological complications |
| E11.40–E11.49 | Type 2 diabetes with diabetic neurological complications |
| G25.81 | Restless legs syndrome (Willis-Ekbom disease) |
| G50.0–G59 | Nerve, nerve root and plexus disorders |
| G62.89 | Other specified polyneuropathies (small fiber neuropathy) |
| G62.9 | Polyneuropathy, unspecified (POEMS syndrome) |
| G89.0 | Central pain syndrome (post-stroke) |
| G89.11–G89.18 | Acute post-operative pain |
| G89.21–G89.29 | Chronic pain |
| G89.3 | Neoplasm-related pain (acute or chronic) |
| I49.8 | Other specified cardiac arrhythmias (postural orthostatic tachycardia) |
| L29.0–L29.9 | Pruritus (chronic itch), various types |
| M25.511–M25.519 | Pain in shoulder |
| M50.00–M54.9 | Other dorsopathies |
| M60.1, M60.10–M60.15 | Myositis |
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