Aetna modified CPB 0388, its complementary and alternative medicine coverage policy, effective September 26, 2025. Here's what billing teams need to know about the updated medical necessity criteria and the 63 CPT and 17 HCPCS codes now governed by this policy.
Aetna, a CVS Health company, updated CPB 0388 to clarify which alternative medicine interventions meet medical necessity standards under peer-reviewed evidence requirements. The revised policy touches a wide range of services — from acupuncture (CPT 97810–97814) and biofeedback (CPT 90875, 90876, 90901, 90912) to chiropractic care (CPT 98940–98943) and electrical stimulation (CPT 97014, 97032). It also draws hard lines around what won't be covered, including IV micronutrient therapy, colonic lavage (CPT 0736T), and a long list of services Aetna classifies as experimental. If your practice bills any of these codes to Aetna, the September 26, 2025 effective date applies to you now.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Complementary and Alternative Medicine |
| Policy Code | CPB 0388 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Chiropractic, Physical Medicine & Rehabilitation, Integrative Medicine, Behavioral Health, Pain Management, Naturopathy |
| Key Action | Audit all CAM-related claims against the updated medical necessity criteria before submitting for dates of service on or after September 26, 2025 |
Aetna Complementary and Alternative Medicine Coverage Criteria and Medical Necessity Requirements 2025
The core of the CPB 0388 Aetna coverage policy is straightforward: Aetna covers alternative medicine interventions only when peer-reviewed published medical literature supports their safety and effectiveness. "Adequate evidence" is doing real work in that sentence. Vague or anecdotal clinical rationale won't hold up at audit.
Aetna considers the following interventions medically necessary for properly selected members, subject to plan limitations:
| # | Covered Indication |
|---|---|
| 1 | Acupuncture — governed by CPB 0135 (CPT 97810, +97811, 97813, +97814) |
| 2 | Biofeedback — governed by CPB 0132 (CPT 90875, 90876, 90901, 90912, +90913) |
| 3 | Chelation therapy — governed by CPB 0234 |
| 4 | Chiropractic services — governed by CPB 0107 (CPT 98940, 98941, 98942, 98943) |
| 5 | Electrical stimulation for pain — governed by CPB 0011 (CPT 20974, 20975, 64550, 97014, 97032) |
Each of these has its own companion CPB with detailed coverage criteria. CPB 0388 points to them. That structure matters for your billing workflow: a claim denial on CPT 98941 ties back to CPB 0107, not just CPB 0388. Make sure your team knows which CPB controls which service.
Prior authorization requirements are plan-specific under CPB 0388. Check individual member benefits before submitting. Some Aetna commercial plans require prior auth for chiropractic and acupuncture above a visit threshold. Others don't. Reimbursement also varies by plan — don't assume fee schedule parity across Aetna products.
The "properly selected members" language is worth flagging. Aetna will look at whether the member actually meets the documented clinical criteria for the service. Document the indication clearly. If you're billing CPT 97810 for acupuncture, the chart needs to support why this patient qualifies under CPB 0135.
Aetna Complementary and Alternative Medicine Exclusions and Non-Covered Indications
This is where the policy gets specific — and where most claim denials will come from.
Aetna explicitly classifies a significant cluster of CAM services as experimental, investigational, or not medically necessary. These services will not be covered regardless of clinical rationale. The policy groups several of these together under the same non-covered bucket.
Services not covered under CPB 0388 include:
| # | Excluded Procedure |
|---|---|
| 1 | Colonic lavage / colonic cleansing (CPT 0736T) — not covered |
| 2 | Virtual reality procedural dissociation services (CPT 0771T, 0772T, 0773T, 0774T) — not covered |
| 3 | Continuous in-person monitoring and intervention services (CPT 0820T, 0821T, 0822T) — not covered |
| 4 | Hypnotherapy (CPT 90880) — not covered |
| 5 | Intravenous micronutrient therapy / Myers' cocktail (CPT 96360 for IV infusion hydration) — not covered |
| 6 | Biophotonic therapy / actinotherapy (CPT 96900) — not covered |
| 7 | Acoustic therapy for anxiety/depression — not covered |
| 8 | Total antioxidant testing (CPT 86353) — not covered |
| 9 | Column chromatography / mass spectrometry for CAM purposes (CPT 82542) — not covered |
| 10 | Laetrile / amygdalin / Vitamin B-17 (HCPCS J3570) — not covered |
| 11 | Cellular therapy (HCPCS M0075) — not covered |
| 12 | IV chelation therapy for cardiovascular indications (HCPCS M0300) — not covered separately from CPB 0234 criteria |
| 13 | Hair analysis (CPT 96902, HCPCS P2031) — not covered |
| 14 | Equestrian/hippotherapy (HCPCS S8940) — not covered |
| 15 | Pilates exercise classes (HCPCS S9451) — not covered |
| 16 | Wilderness programs (HCPCS T2036, T2037) — not covered |
| 17 | Traditional healing services (HCPCS H0051) — not covered |
| 18 | Activity therapy (HCPCS G0176) — not covered under this policy |
| 19 | Micronutrient panels (CPT 82136, 82180, 82306, 82310, 82379, 82495, 82525, 82607, 82652, 82725, 82746, 82978, 83735, 83785, 84207, 84252, 84255, 84425, 84446, 84590, 84591, 84597, 84630) — not covered for IV micronutrient therapy purposes |
| 20 | Cari Loder regimen (HCPCS J3420, J1955, HCPCS J3475) — not covered |
| 21 | Parenteral nutrition for micronutrient purposes (HCPCS B4172) — not covered |
The micronutrient panel list is long and worth reading twice. Billing CPT 82306 (Vitamin D, 25 hydroxy) or CPT 82607 (Vitamin B-12) in the context of IV micronutrient therapy will trigger denial under this policy. The same labs billed for a covered indication under a different clinical context may be fine — but the diagnosis and clinical documentation need to support that distinction clearly.
If your practice offers Myers' cocktail or similar IV nutrient infusions and bills CPT 96360, stop. Aetna's CPB 0388 coverage policy is unambiguous. These claims will deny.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Acupuncture | Covered (per CPB 0135) | CPT 97810, +97811, 97813, +97814 | "Properly selected members"; see CPB 0135 for full criteria |
| Biofeedback | Covered (per CPB 0132) | CPT 90875, 90876, 90901, 90912, +90913 | See CPB 0132 for full criteria |
| Chelation therapy | Covered (per CPB 0234) | — | Narrow indications; see CPB 0234 |
| Chiropractic services | Covered (per CPB 0107) | CPT 98940, 98941, 98942, 98943 | See CPB 0107; prior auth may apply |
| Electrical stimulation for pain | Covered (per CPB 0011) | CPT 20974, 20975, 64550, 97014, 97032; HCPCS A4595, E0720, E0730 | See CPB 0011 for full criteria |
| IV micronutrient therapy / Myers' cocktail | Not Covered | CPT 96360; HCPCS B4172, J3475, J1955 | Explicitly excluded |
| Colonic lavage / colonic cleansing | Not Covered | CPT 0736T | Explicitly excluded |
| Hypnotherapy | Not Covered | CPT 90880 | Explicitly excluded |
| Virtual reality dissociation services | Not Covered | CPT 0771T, 0772T, 0773T, 0774T | Explicitly excluded |
| Continuous in-person monitoring services | Not Covered | CPT 0820T, 0821T, 0822T | Explicitly excluded |
| Biophotonic / actinotherapy | Not Covered | CPT 96900 | Explicitly excluded |
| Hair analysis | Not Covered | CPT 96902; HCPCS P2031 | Explicitly excluded |
| Micronutrient panels (CAM context) | Not Covered | CPT 82136, 82180, 82306, 82310, 82379, 82495, 82525, 82607, 82652, 82725, 82746, 82978, 83735, 83785, 84207, 84252, 84255, 84425, 84446, 84590, 84591, 84597, 84630 | Excluded when billed in IV micronutrient therapy context |
| Laetrile / amygdalin | Not Covered | HCPCS J3570 | Explicitly excluded |
| Cellular therapy | Not Covered | HCPCS M0075 | Explicitly excluded |
| Traditional healing services | Not Covered | HCPCS H0051 | Explicitly excluded |
| Equestrian / hippotherapy | Not Covered | HCPCS S8940 | Explicitly excluded |
| Pilates classes | Not Covered | HCPCS S9451 | Explicitly excluded |
| Wilderness therapy programs | Not Covered | HCPCS T2036, T2037 | Explicitly excluded |
| Acoustic therapy for anxiety/depression | Not Covered | — | Explicitly excluded |
| Cari Loder regimen | Not Covered | HCPCS J3420, J1955, J3475 | Explicitly excluded |
| Activity therapy (music, dance, art, play) | Not Covered | HCPCS G0176 | Not covered under this policy |
| Total antioxidant testing | Not Covered | CPT 86353 | Explicitly excluded |
Aetna Complementary and Alternative Medicine Billing Guidelines and Action Items 2025
The updated Aetna alternative medicine billing guidelines require action before you submit any CAM-related claims for dates of service on or after September 26, 2025.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for all non-covered CPT and HCPCS codes. Pull a 90-day claim history and flag any claims containing CPT 0736T, 90880, 96360, 0771T–0774T, 0820T–0822T, 96900, or any of the micronutrient panel codes (82136, 82180, 82306, 82310, and the full list above). These will deny. Remove them from your charge master for Aetna if they are being billed in a CAM context. |
| 2 | Separate your micronutrient lab billing by clinical context. CPT 82306 and CPT 82607 are not universally excluded — they're excluded specifically in the IV micronutrient therapy context. If you bill these for non-CAM indications, the diagnosis must clearly support a different clinical purpose. Talk to your compliance officer if your documentation process doesn't already distinguish between contexts. |
| 3 | Check companion CPBs before submitting covered CAM services. Billing CPT 98940–98943 for chiropractic? The governing criteria live in CPB 0107, not CPB 0388. Billing CPT 97810 or 97813 for acupuncture? Check CPB 0135. Each covered service has its own coverage policy with distinct medical necessity criteria. Your billing team needs to reference both the parent policy and the companion CPB. |
| 4 | Verify prior authorization requirements by plan before submitting. Prior auth requirements vary across Aetna commercial, Medicare Advantage, and Medicaid products. Pull eligibility and benefits before the claim goes out. This is especially true for chiropractic (CPT 98940–98943) and acupuncture (CPT 97810, 97813) where visit limits and prior auth thresholds differ by plan design. |
| 5 | Update your ABN process for non-covered services. If your practice offers any of the excluded services — hippotherapy (HCPCS S8940), wilderness programs (T2036, T2037), Myers' cocktail (CPT 96360) — and your patient has Aetna coverage, issue an Advance Beneficiary Notice equivalent for commercial plans. Document that the patient was informed Aetna will not cover the service. This protects your practice and sets accurate patient financial expectations. |
| 6 | Review any outstanding claims from before September 26, 2025 for overlap. If you have claims pending that include excluded codes, consider whether resubmission with corrected coding is appropriate. If you're not sure whether a previously submitted claim creates exposure, loop in your billing consultant before taking action. |
| 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 Complementary and Alternative Medicine Under CPB 0388
Covered CPT Codes (When Medical Necessity Criteria Are Met Per Companion CPBs)
| Code | Type | Description |
|---|---|---|
| 20974 | CPT | Electrical stimulation to aid bone healing; noninvasive (nonoperative) |
| 20975 | CPT | Electrical stimulation to aid bone healing; invasive (operative) |
| 64550 | CPT | Application of surface (transcutaneous) neurostimulator |
| 90875 | CPT | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with patient) |
| 90876 | CPT | Individual psychophysiological therapy incorporating biofeedback training; approximately 45–50 minutes |
| 90901 | CPT | Biofeedback training by any modality |
| 90912 | CPT | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry |
| +90913 | CPT | Biofeedback training, perineal muscles; each additional 15 minutes |
| 97014 | CPT | Application of a modality to one or more areas; electrical stimulation (unattended) |
| 97032 | CPT | Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes |
| 97039 | CPT | Unlisted modality (specify type and time if constant attendance) |
| 97110 | CPT | Therapeutic exercises to develop strength and endurance, range of motion and flexibility, each 15 minutes |
| 97124 | CPT | Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) |
| 97139 | CPT | Unlisted therapeutic procedure (specify) |
| 97140 | CPT | Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) |
| 97150 | CPT | Therapeutic procedure(s), group (two or more individuals) |
| 97530 | CPT | Therapeutic activities, direct (one-on-one) patient contact |
| 97799 | CPT | Unlisted physical medicine/rehabilitation service or procedure |
| 97810 | CPT | Acupuncture, one or more needles, without electrical stimulation; initial 15 minutes |
| +97811 | CPT | Acupuncture without electrical stimulation; each additional 15 minutes |
| 97813 | CPT | Acupuncture with electrical stimulation; initial 15 minutes |
| +97814 | CPT | Acupuncture with electrical stimulation; each additional 15 minutes |
| 98940 | CPT | Chiropractic manipulative treatment (CMT); spinal, one to two regions |
| 98941 | CPT | CMT; spinal, three to four regions |
| 98942 | CPT | CMT; spinal, five regions |
| 98943 | CPT | CMT; extraspinal, one or more regions |
Not Covered / Experimental CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0736T | CPT | Colonic lavage, 35 or more liters of water, gravity-fed, with induced defecation | Colonic cleansing — not covered |
| 0771T | CPT | Virtual reality (VR) procedural dissociation services; same physician | Not covered |
| 0772T | CPT | VR procedural dissociation; each additional 15 minutes (add-on) | Not covered |
| 0773T | CPT | VR procedural dissociation services; different physician | Not covered |
| 0774T | CPT | VR procedural dissociation; each additional 15 minutes (add-on) | Not covered |
| 0820T | CPT | Continuous in-person monitoring and intervention (e.g., psychotherapy, crisis intervention) | Not covered |
| 0821T | CPT | Continuous in-person monitoring; second physician concurrent | Not covered |
| 0822T | CPT | Continuous in-person monitoring; clinical staff under physician direction | Not covered |
| 82542 | CPT | Column chromatography including mass spectrometry (e.g., HPLC, LC/MS) | Not covered in CAM context |
| 86353 | CPT | Lymphocyte transformation, mitogen or antigen induced blastogenesis [total antioxidant] | Not covered |
| 90880 | CPT | Hypnotherapy | Not covered |
| 96360 | CPT | Intravenous infusion, hydration; initial 31 minutes to 1 hour | Not covered for IV micronutrient therapy |
| 96900 | CPT | Actinotherapy (ultraviolet light) [Biophotonic Therapy] | Not covered |
| 96902 | CPT | Microscopic examination of hairs plucked or clipped by examiner | Not covered |
| 82136 | CPT | Amino acids, 2 to 5 amino acids, quantitative [micronutrient] | Not covered in IV micronutrient context |
| 82180 | CPT | Ascorbic acid (Vitamin C), blood [micronutrient] | Not covered in IV micronutrient context |
| 82306 | CPT | Vitamin D; 25 hydroxy [micronutrient] | Not covered in IV micronutrient context |
| 82310 | CPT | Calcium; total [micronutrient] | Not covered in IV micronutrient context |
| 82379 | CPT | Carnitine (total and free), quantitative [micronutrient] | Not covered in IV micronutrient context |
| 82495 | CPT | Chromium [micronutrient] | Not covered in IV micronutrient context |
| 82525 | CPT | Copper [micronutrient] | Not covered in IV micronutrient context |
| 82607 | CPT | Cyanocobalamin (Vitamin B-12) [micronutrient] | Not covered in IV micronutrient context |
| 82652 | CPT | Vitamin D; 1, 25 dihydroxy [micronutrient] | Not covered in IV micronutrient context |
| 82725 | CPT | Fatty acids, nonesterified [micronutrient] | Not covered in IV micronutrient context |
| 82746 | CPT | Folic acid; serum [micronutrient] | Not covered in IV micronutrient context |
| 82978 | CPT | Glutathione [micronutrient] | Not covered in IV micronutrient context |
| 83735 | CPT | Magnesium [micronutrient] | Not covered in IV micronutrient context |
| 83785 | CPT | Manganese [micronutrient] | Not covered in IV micronutrient context |
| 84207 | CPT | Pyridoxal phosphate (Vitamin B-6) [micronutrient] | Not covered in IV micronutrient context |
| 84252 | CPT | Riboflavin (Vitamin B-2) [micronutrient] | Not covered in IV micronutrient context |
| 84255 | CPT | Selenium [micronutrient] | Not covered in IV micronutrient context |
| 84425 | CPT | Thiamine (Vitamin B-1) [micronutrient] | Not covered in IV micronutrient context |
| 84446 | CPT | Tocopherol alpha (Vitamin E) [micronutrient] | Not covered in IV micronutrient context |
| 84590 | CPT | Vitamin A [micronutrient] | Not covered in IV micronutrient context |
| 84591 | CPT | Vitamin, not otherwise specified [micronutrient] | Not covered in IV micronutrient context |
| 84597 | CPT | Vitamin K [micronutrient] | Not covered in IV micronutrient context |
| 84630 | CPT | Zinc [micronutrient] | Not covered in IV micronutrient context |
Not Covered / Experimental HCPCS Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| B4172 | HCPCS | Parenteral nutrition solution; amino acid, 5.5%–7%, homemix (500 ml = 1 unit) | Not covered for IV micronutrient therapy |
| G0176 | HCPCS | Activity therapy (music, dance, art, or play therapies) not for recreation | Not covered under this policy |
| H0051 | HCPCS | Traditional healing service | Not covered |
| J1955 | HCPCS | Injection, levocarnitine, per 1 gm [Cari Loder regimen] | Not covered |
| J3420 | HCPCS | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg [Cari Loder regimen] | Not covered |
| J3475 | HCPCS | Injection, magnesium sulfate, per 500 mg | Not covered for IV micronutrient therapy |
| J3570 | HCPCS | Laetrile, amygdalin, vitamin B-17 | Not covered |
| M0075 | HCPCS | Cellular therapy | Not covered |
| M0300 | HCPCS | IV chelation therapy (chemical endarterectomy) | See CPB 0234 for covered indications |
| P2031 | HCPCS | Hair analysis (excluding arsenic) | Not covered |
| S8940 | HCPCS | Equestrian/hippotherapy, per session | Not covered |
| S9451 | HCPCS | Exercise classes, nonphysician provider, per session [pilates] | Not covered |
| T2036 | HCPCS | Therapeutic camping, overnight, waiver; each session [Wilderness Program] | Not covered |
| T2037 | HCPCS | Therapeutic camping, day, waiver; each session [Wilderness Program] | Not covered |
Covered HCPCS Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| A4595 | HCPCS | Electrical stimulator supplies, 2 lead, per month (e.g., TENS, NMES) |
| E0720 | HCPCS | TENS device, two leads, localized stimulation |
| E0730 | HCPCS | TENS device, four or more leads, for multiple nerve stimulation |
Key ICD-10-CM Diagnosis Codes
The full policy lists 310 ICD-10-CM codes. The policy data provided includes the group structure but not the complete individual code list in this summary. Access the complete ICD-10 code list directly at the CPB 0388 source policy. Your billing team should cross-reference the diagnosis codes on every CAM-related claim against the covered indications in the companion CPBs (0135, 0132, 0234, 0107, 0011) before submission.
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