Hypertensive Disorders of Pregnancy — CPB 0368 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0368 covering hypertensive disorders of pregnancy, effective September 26, 2025. CPT 0390U and HCPCS codes S9211, S9212, and S9213 are explicitly excluded from coverage under this policy. Here's what billing teams need to know.

Aetna's updated coverage policy under CPB 0368 draws a hard line on four specific codes tied to hypertensive disorders of pregnancy. If your practice or health system bills for preeclampsia risk testing, home blood pressure management programs, or postpartum hypertension monitoring, this update directly affects your reimbursement and denial exposure. The policy spans 79 ICD-10-CM diagnosis codes across the full spectrum of maternal hypertension conditions—from pre-existing hypertension complicating pregnancy (O10 series) through eclampsia (O15 series) and unspecified maternal hypertension (O16 series).

Quick-Reference Table

Aetna Hypertensive Disorders of Pregnancy Coverage Criteria and Medical Necessity Requirements 2025

Aetna's hypertensive disorders of pregnancy coverage policy under CPB 0368 is notable for what it does not cover as much as what it does. The policy explicitly excludes four codes from coverage for the indications listed in the CPB. That language—"indications listed in the CPB"—is doing a lot of work here.

The four excluded codes are CPT 0390U, a proprietary lab test for obstetric preeclampsia risk using kinase insert domain receptor (KDR) and endoglin (ENG) biomarkers (note: the full code description is truncated in the source policy), and HCPCS S9211, S9212, and S9213, which cover home management programs for gestational hypertension, postpartum hypertension, and preeclampsia respectively.

Each of those home management HCPCS codes bundles together administrative services, professional pharmacy services, and care coordination. These are programs that many practices and specialty pharmacies have been offering to high-risk obstetric patients. Aetna is saying directly: they don't meet medical necessity criteria for coverage under CPB 0368.

If your billing team has been submitting these codes against Aetna hypertensive disorders of pregnancy billing claims, stop. Continuing to bill them against the 79 ICD-10-CM codes listed in this policy will generate claim denial.

Aetna's position on CPT 0390U deserves particular attention. This is a proprietary lab test marketed for preeclampsia risk stratification using KDR and endoglin (ENG) biomarkers. Aetna does not consider it covered for the indications listed in CPB 0368. If you bill 0390U for an Aetna patient with a diagnosis from the O10–O16 code range, expect denial.

CPB 0368 does not address prior authorization requirements. Check individual plan terms independently for any prior auth obligations on non-excluded services billed with O10–O16 diagnoses.

Aetna Hypertensive Disorders of Pregnancy Exclusions and Non-Covered Indications

This is where the policy bites. Aetna classifies all four codes in CPB 0368 as "not covered for indications listed in the CPB." That's a categorical exclusion—not a case-by-case medical necessity determination.

CPT 0390U covers a molecular biomarker test for preeclampsia using KDR and endoglin (ENG). Aetna excludes this test for the indications listed in this CPB.

HCPCS S9211 covers home management of gestational hypertension. S9212 covers home management of postpartum hypertension. S9213 covers home management of preeclampsia. All three bundle professional pharmacy services and care coordination into a single code.

The real issue here is that S9211, S9212, and S9213 are S-codes—which means many commercial payers were already inconsistent in covering them. Aetna's policy update makes its position explicit and on record. If you've been billing these and getting paid, consider auditing your recent claims as a general compliance practice—independent of what this policy states.

Coverage Indications at a Glance

Aetna Hypertensive Disorders of Pregnancy Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. Here's what your billing team needs to do before and after that date.

CPT, HCPCS, and ICD-10 Codes for Hypertensive Disorders of Pregnancy Under CPB 0368

Not Covered CPT Codes

Not Covered HCPCS Codes

Key ICD-10-CM Diagnosis Codes