Breast Transillumination, Electrical Impedance Scanning (EIS), and Elastography — CPB 0386 | AETNA Coverage Update

Aetna modified CPB 0386 covering breast transillumination, electrical impedance scanning (EIS), and elastography, effective September 26, 2025. Here's what billing teams need to know.

Aetna, a CVS Health company, updated this coverage policy to address a broad set of breast imaging technologies under CPB 0386 Aetna system. The affected codes include elastography CPTs 76981, 76982, 76983, and 76391, along with Category III codes 0351T through 0354T, 0422T, 0689T, and 0690T. If your practice bills any of these codes for Aetna members, this policy revision determines whether you get paid—or denied.

Quick-Reference Table

Aetna Breast Imaging Coverage Criteria and Medical Necessity Requirements 2025

The core issue with CPB 0386 is that Aetna draws a hard line between established, covered breast imaging—primarily screening mammography—and newer technologies that it considers experimental or investigational. That distinction drives every claim decision under this policy.

Aetna's coverage policy treats transillumination, EIS, and elastography as distinct from standard mammographic screening (CPTs 77065, 77066, 77067). Screening mammography has a clear covered path. The newer imaging technologies in this bulletin don't share that status.

Medical necessity under this policy centers on whether the imaging technology has sufficient clinical evidence to support a coverage determination. Aetna's position on elastography (76981, 76982, 76983) and MR elastography (76391) is that evidence-based clinical utility in breast-specific indications remains unestablished. The same applies to the Category III codes.

If your team has been billing 76981 or 76982 alongside breast ultrasound for tissue characterization, those claims are at high risk under this coverage policy. Prior authorization won't fix the problem if the service itself is non-covered. Verify coverage status before submitting—not after a claim denial.

Medical necessity documentation requirements still apply to everything in this policy. Even for covered services like screening mammography under 77065–77067, your documentation needs to support the specific indication billed. Don't let a broader policy review distract you from the basics.

Aetna Breast Imaging Exclusions and Non-Covered Indications

This is where the policy has real financial teeth for billing teams.

Aetna classifies breast transillumination as having no specific covered CPT code. That grouping label appears across codes 0351T, 0352T, 0353T, 0354T, and 0422T. Billing any of these for Aetna members will likely result in claim denial as experimental or investigational.

Electrical impedance scanning has the same problem. EIS lacks a specific approved CPT code under Aetna's framework, and the technology itself doesn't meet Aetna's clinical evidence threshold for coverage.

The elastography codes—76981, 76982, 76983, and 76391—fall under the same non-specific grouping in the policy data. Aetna's position is consistent with how other major payers have treated elastography in breast tissue: the evidence for standalone diagnostic utility is insufficient to support routine reimbursement.

The quantitative ultrasound tissue characterization codes, 0689T and 0690T, are also in this non-covered bucket. These are relatively new Category III codes, and Aetna's bulletin treats them as unproven for breast applications.

The real issue here is scope. This isn't one or two outlier codes—it's a full sweep of emerging breast imaging technology. If your practice has been billing any of these expecting reimbursement, stop and audit those claims now.

Coverage Indications at a Glance

Aetna Breast Transillumination and Elastography Billing Guidelines and Action Items 2025

These steps apply starting September 26, 2025. Don't wait until you get a wave of denials to act.

1. Pull all active orders for CPTs 76981, 76982, 76983, and 76391.
If your radiologists or breast imaging team orders elastography for Aetna members, flag those orders now. Submitting them after September 26, 2025 without verifying coverage will generate denials that are hard to appeal when the service is classified as non-covered.

2. Remove 0351T, 0352T, 0353T, 0354T, 0422T, 0689T, and 0690T from your Aetna charge capture entirely.
These codes have no covered path under CPB 0386. They aren't a prior authorization issue—they're a coverage issue. Charging them to Aetna creates billing exposure without a realistic reimbursement path.

3. Audit claims submitted between January 1, 2025 and September 26, 2025 for these codes.
If you've been billing any of the non-covered codes and receiving payment, understand that policy modifications often trigger retroactive claim review. Get ahead of any potential take-backs by reviewing that claim history now.

4. Update your elastography billing guidelines for Aetna specifically.
Elastography CPTs 76981–76983 may be covered by other payers for non-breast applications. Make sure your billing guidelines flag Aetna separately so your team doesn't automatically apply coverage assumptions from other payers to this population.

5. Verify screening mammography billing remains clean.
CPTs 77065, 77066, and 77067 are the covered path for Aetna breast screening. If your practice bills both mammography and any of the experimental technologies in the same encounter, separate those claims carefully. Bundling covered and non-covered services in the same claim creates denial risk for everything.

6. Communicate the change to your ordering physicians.
Surgeons billing 19301 and 19302 for partial mastectomy should know that any intraoperative use of OCT (0351T–0354T) won't be separately reimbursed under Aetna's CPB 0386. If providers expect separate reimbursement for those services, correct that expectation now.

7. Talk to your compliance officer if you're unsure how this applies to your payer mix.
If Aetna represents a significant share of your breast imaging volume, the financial exposure here is real. Your compliance officer should review current billing practices against this updated policy before the effective date of September 26, 2025.

CPT, HCPCS, and ICD-10 Codes for Breast Transillumination, EIS, and Elastography Under CPB 0386

Not Covered / Experimental CPT Codes

Key ICD-10-CM Diagnosis Codes Under CPB 0386

These diagnosis codes appear in the policy. They provide clinical context for breast imaging claims. Pairing them with non-covered CPTs does not create a covered claim.

The full ICD-10 set under CPB 0386 runs 106 codes. Use the specific code that matches the documented diagnosis—not an unspecified code when a more precise one exists. Unspecified codes are an easy trigger for medical necessity challenges on any breast imaging claim.