Trigeminal Neuralgia: Treatments — CPB 0374 | AETNA Coverage Update

Aetna modified CPB 0374 for trigeminal neuralgia treatments, effective February 25, 2026. Here's what billing teams need to do.

Aetna, a CVS Health company, updated its trigeminal neuralgia coverage policy under CPB 0374 in the Aetna system. The policy governs surgical and interventional treatments for trigeminal neuralgia, covering CPT codes 61450, 61458, 61790, 61796, 64400, 64600, 64605, and 64610, along with CyberKnife and Gamma Knife radiosurgery codes G0339 and G0340. If your practice bills for neurosurgical, pain management, or stereotactic radiosurgery procedures on Aetna patients, this coverage policy update directly affects your reimbursement.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna
Policy	Trigeminal Neuralgia: Treatments — CPB 0374
Policy Code	CPB 0374
Change Type	Modified
Effective Date	February 25, 2026
Impact Level	High
Specialties Affected	Neurosurgery, Pain Management, Radiation Oncology, Neurology
Key Action	Audit charge capture for experimental procedure codes — 31 interventions are now explicitly non-covered under this policy

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Aetna Trigeminal Neuralgia Coverage Criteria and Medical Necessity Requirements 2026

The Aetna trigeminal neuralgia coverage policy sets a clear bar for surgical medical necessity. Aetna covers surgical intervention only when the condition has persisted for at least six months despite conservative pharmacotherapy — specifically carbamazepine, phenytoin, and baclofen — or when the member cannot tolerate side effects from those drugs.

That six-month threshold is the gate. Document it clearly in the medical record before you bill CPT 61450, 61458, or 61790. Missing that documentation is the fastest path to a claim denial.

Six specific surgical procedures meet the medical necessity standard when that threshold is crossed:

Aetna also covers trigeminal nerve blocks — billed under CPT 64400 — for refractory cases. Note the word "refractory." Standard cases don't qualify. The record needs to show the patient failed conservative treatment before you bill 64400 and expect reimbursement.

Prior authorization requirements are not explicitly detailed in this version of CPB 0374, but given the surgical nature of these procedures, confirm prior auth requirements with Aetna directly before scheduling. Stereotactic radiosurgery in particular — CyberKnife, Gamma Knife, linear accelerator — typically carries prior authorization requirements under Aetna's related policy CPB 0083. Check both policies before you submit.

The trigeminal neuralgia billing guidelines here are stricter than they look. "Persisted for at least 6 months" and "despite conservative treatment" are both hard criteria. Aetna will look for both in the record. Build your clinical documentation workflow around those two checkpoints.

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Aetna Trigeminal Neuralgia Exclusions and Non-Covered Indications

This is where the update gets consequential. Aetna's revised CPB 0374 lists 31 procedures as experimental, investigational, or unproven. That's a long list — and several of these have CPT and HCPCS codes your team may already have in charge capture.

The real issue here is that some of these procedures are actively being offered at pain clinics and neurology practices under the assumption that coverage exists. It doesn't — not under this policy.

Procedures explicitly designated non-covered include:

One note on peripheral neurectomy: Aetna lists it as experimental in the policy text. However, CPT 64732 and 64734 — which describe transection or avulsion of the supraorbital and infraorbital nerves — are assigned to the covered codes group in the source policy data, not the experimental group. The policy does not explicitly map peripheral neurectomy to those codes. Don't assume CPT 64732 or 64734 are automatically non-covered for trigeminal neuralgia — but if your practice bills peripheral neurectomy for this indication, loop in your compliance officer before submitting. The tension between the clinical exclusion and the code grouping is real and needs practice-level review.

Bleomycin sclerotherapy (J9040), percutaneous ozone injection, topical ambroxol, topical lidocaine, and adipose-derived stem cells (CPT 15769, 15773, 15774, 20926) are also on the excluded list. None of these will get paid for trigeminal neuralgia under CPB 0374.

If your billing team sees these codes attached to a trigeminal neuralgia diagnosis and an Aetna payer, expect a denial. Flag them in your pre-bill review workflow now, before February 25, 2026.

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Coverage Indications at a Glance

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Aetna Trigeminal Neuralgia Billing Guidelines and Action Items 2026

The effective date is February 25, 2026. Here's what your billing team needs to do before then.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Trigeminal Neuralgia Under CPB 0374

Covered CPT Codes (When Selection Criteria Are Met)

Covered HCPCS Codes (When Selection Criteria Are Met)

Other CPT Codes Related to CPB 0374 (Diagnostic and Adjunct)

Other HCPCS Codes Related to CPB 0374 (Pharmacotherapy Reference)

Code	Type	Description	Notes Copy
J0475	HCPCS	Injection baclofen, 10 mg	Conservative pharmacotherapy reference — documented failure of baclofen (along with carbamazepine and phenytoin) is required before surgical coverage applies. These are not experimental codes.
J1165	HCPCS	Injection, phenytoin sodium, per 50 mg	Conservative pharmacotherapy reference — same as above.

Not Covered / Experimental CPT Codes Under CPB 0374

Not Covered / Experimental HCPCS Codes Under CPB 0374

Key ICD-10-CM Diagnosis Codes

The policy data for CPB 0374 does not list specific ICD-10-CM codes. Use your standard trigeminal neuralgia diagnosis codes and confirm with Aetna's claims editing system before submission.

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