TL;DR: Aetna, a CVS Health company, modified CPB 0390 governing smell and taste disorder diagnosis coverage, effective September 26, 2025. Here's what billing teams need to know before claims start moving through.
This update to the Aetna smell and taste disorders coverage policy defines which diagnostic services Aetna considers medically necessary for olfactory and gustatory dysfunction — conditions like anosmia, hyposmia, ageusia, and dysgeusia. The policy covers a broad range of procedures under CPB 0390 Aetna system, from nasal endoscopy (CPT 31231) and neuroimaging (CPT 70450–70553) to standardized olfactory testing and a full hematological workup. It also draws a firm line around what Aetna will not cover — and the exclusions have real claim denial risk attached to them.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Smell and Taste Disorders – Diagnosis |
| Policy Code | CPB 0390 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium |
| Specialties Affected | Otolaryngology (ENT), Neurology, Psychiatry, Clinical Lab, Radiology |
| Key Action | Audit your charge capture for CPT 31231, 70551–70553, and the 80150–80199 drug assay range before billing Aetna for smell/taste evaluations |
Aetna Smell and Taste Disorder Coverage Criteria and Medical Necessity Requirements 2025
CPB 0390 is the Aetna coverage policy that defines medical necessity for diagnosing unexplained olfactory dysfunction — anosmia, hyposmia, and dysosmia — and gustatory dysfunction — ageusia, hypogeusia, and dysgeusia. The word "unexplained" is doing heavy lifting here. Aetna covers these services as part of a structured diagnostic workup, not as standalone billable events with no clinical context.
Thirteen categories of procedures meet Aetna's medical necessity standard under this policy. These include:
| # | Covered Indication |
|---|---|
| 1 | Biopsy of the olfactory mucosa (CPT 30100) |
| 2 | Drug assays and chemical analyses (CPT 80150–80199 range) when medication side effects or nutritional deficiencies are the suspected cause |
| 3 | EEG — but only for members with a documented history of seizures |
| 4 | Hematological testing including hematocrit (CPT 85014), hemoglobin (CPT 85018), WBC (CPT 85048), erythrocyte sedimentation rate (CPT 85651–85652), eosinophil count (CPT 85032), IgE (CPT 86003), creatinine (CPT 82565), urea nitrogen (CPT 84520), and glucose (CPT 82947) |
| 5 | Complete medical history and physical exam |
| 6 | Nasal endoscopy (CPT 31231) |
| 7 | CT or MRI neuroimaging — specifically CPT 70450, 70460, 70470, 70496 for CT, and 70551, 70552, 70553 for MRI — to rule out intracranial or peripheral nerve abnormalities |
| 8 | Neurological, otolaryngological, and psychiatric consultations |
| 9 | Standard taste tests — Taste-Threshold, Taste-Suprathreshold, Taste-Quadrant, and Flavor Discrimination tests |
| 10 | Standardized olfactory tests — UPSIT, Sniffin' Sticks, the University of Connecticut Test Battery, Pocket Smell Test, Brief Smell Identification Test, plus Smell-Threshold, Smell-Suprathreshold, and Smell Unilateral tests |
| 11 | Thyroid function studies (CPT 84443) |
Two policy notes carry serious billing implications. First: Aetna considers only an initial visit and one follow-up visit medically necessary for smell and taste dysfunction testing. Additional testing visits are not medically necessary. Second: members with taste loss may also require smell testing — so don't leave olfactory testing off the claim when the presenting complaint is gustatory.
If your practice is billing Aetna for repeat testing visits beyond that initial-plus-one-follow-up structure, those claims are headed for denial under this coverage policy. That's not a maybe — that's the explicit language in CPB 0390.
Aetna Smell and Taste Disorder Exclusions and Non-Covered Indications
This is where the policy gets specific about what Aetna will not pay for. The codes listed under the "not covered" group include orbital/face/neck MRI (CPT 70540, 70542, 70543), urea breath testing for H. pylori (CPT 78267, 78268, 83013, 83014), H. pylori antigen detection (CPT 87338), nasal function studies such as rhinomanometry (CPT 92512), nitric oxide expired gas determination (CPT 95012), and brain PET metabolic evaluation (CPT 78608).
Genotyping of the TAS2R38 gene — a bitter taste receptor gene sometimes studied in the context of taste dysfunction — is also not covered under this policy. Neither is cerebrospinal fluid SARS-CoV testing in this context.
The real issue here is that several of these excluded codes look reasonable from a clinical standpoint. Rhinomanometry (CPT 92512) seems like a logical add-on during a nasal endoscopy workup. Brain PET (CPT 78608) could be tempting when neurological involvement is suspected. Aetna says no to all of them for smell and taste disorder diagnosis — and billing them alongside covered procedures without a distinct medical necessity justification for a separate condition will generate a claim denial.
If a member has a co-existing condition that independently justifies one of these excluded codes, document that clearly and separately. Don't bundle it into the smell/taste workup without clean clinical separation in the record.
Coverage Indications at a Glance
| Indication / Procedure | Status | Relevant Codes | Notes |
|---|---|---|---|
| Olfactory mucosa biopsy | Covered | CPT 30100 | Unexplained olfactory dysfunction required |
| Drug assays / chemical analyses | Covered | CPT 80150–80199 | Only when medication or nutritional deficiency is suspected cause |
| EEG | Covered | — | Only for members with documented seizure history |
| Hematological workup | Covered | CPT 82565, 82947, 84520, 85014, 85018, 85032, 85048, 85651, 85652, 86003 | Standard panel for workup |
| Thyroid function (TSH) | Covered | CPT 84443 | Part of standard diagnostic workup |
| Nasal endoscopy | Covered | CPT 31231 | Diagnostic; separate procedure |
| CT neuroimaging (head/brain) | Covered | CPT 70450, 70460, 70470, 70496 | To rule out intracranial/peripheral nerve abnormality |
| MRI neuroimaging (brain) | Covered | CPT 70551, 70552, 70553 | To rule out intracranial/peripheral nerve abnormality |
| Neurological consultation | Covered | — | Covered as part of workup |
| Otolaryngological consultation | Covered | — | Covered as part of workup |
| Psychiatric consultation | Covered | — | Covered as part of workup |
| Standard taste tests | Covered | — | Whole-Mouth, Suprathreshold, Quadrant, Flavor Discrimination |
| Standardized olfactory tests | Covered | — | UPSIT, Sniffin' Sticks, Pocket Smell Test, Brief SIT, and others |
| Additional testing visits (beyond initial + 1 follow-up) | Not Covered | — | Explicitly non-medically necessary per CPB 0390 |
| MRI orbit/face/neck | Not Covered | CPT 70540, 70542, 70543 | Not covered for this indication |
| Brain PET metabolic evaluation | Not Covered | CPT 78608 | Not covered for smell/taste diagnosis |
| Rhinomanometry / nasal function studies | Not Covered | CPT 92512 | Excluded under this policy |
| Nitric oxide expired gas | Not Covered | CPT 95012 | Not covered for this indication |
| Urea breath test (H. pylori) | Not Covered | CPT 78267, 78268, 83013, 83014 | Excluded |
| H. pylori antigen detection | Not Covered | CPT 87338 | Excluded |
| TAS2R38 genotyping | Not Covered | — | Experimental/investigational |
| CSF SARS-CoV testing | Not Covered | — | Not covered in this context |
Aetna Smell and Taste Disorder Billing Guidelines and Action Items 2025
The effective date is September 26, 2025. That's your line in the sand. Here's what to do before — and after — that date.
| # | Action Item |
|---|---|
| 1 | Audit your visit structure for smell/taste workups. Aetna allows one initial visit and one follow-up for testing. If your practice schedules multiple testing visits as standard protocol, that structure generates claim denials under CPB 0390. Review your scheduling templates and update them now. |
| 2 | Check your charge capture for excluded codes. Pull any encounter templates or order sets used for smell/taste evaluations. Remove CPT 92512, 70540–70543, 78608, 95012, 78267, 78268, 83013, 83014, and 87338 from default order sets tied to this diagnosis group. These codes are not covered for this indication, and billing them will result in denied reimbursement. |
| 3 | Update documentation requirements for drug assay billing. CPT codes in the 80150–80199 range are covered — but only when the clinical suspicion points to medication side effects or nutritional deficiency as the cause. Your documentation needs to say that explicitly. "Rule out drug-induced anosmia" is not enough. Name the suspected drug and the clinical rationale. |
| 4 | Verify EEG documentation before billing. EEG is covered only for members with a documented seizure history. If that history isn't in the chart — or isn't referenced clearly in the note — Aetna has grounds to deny the claim. This is a simple documentation check, but it matters. |
| 5 | Confirm taste-plus-smell testing is reflected on claims when appropriate. The policy says members with taste loss may need smell testing in addition to taste testing. If your clinician orders both, bill both. Leaving olfactory testing off the claim for a gustatory dysfunction patient leaves money on the table. |
| 6 | Separate any non-smell/taste diagnosis codes cleanly on claims. If a patient has an independent condition that justifies an otherwise-excluded code — say, rhinomanometry for a separate nasal obstruction diagnosis — make sure the claim separates those services clearly. The medical necessity and diagnosis linkage needs to be unambiguous. If you're unsure how to structure that on a claim, talk to your billing consultant before the effective date. |
| 7 | Check prior authorization requirements for neuroimaging. CPB 0390 doesn't spell out prior authorization rules directly, but Aetna routinely requires prior auth for MRI and CT studies (CPT 70551–70553 and 70450–70496). Verify your Aetna contract and check Aetna's prior auth requirements for these codes before submitting without it. A clean policy doesn't override a missing auth. |
| 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 Smell and Taste Disorder Diagnosis Under CPB 0390
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 30100 | CPT | Biopsy, intranasal |
| 31231 | CPT | Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) |
| 70450 | CPT | CT head or brain; without contrast material |
| 70460 | CPT | CT head or brain; with contrast material(s) |
| 70470 | CPT | CT head or brain; without contrast, followed by contrast and further sections |
| 70496 | CPT | CT angiography, head, with contrast material(s), including noncontrast images |
| 70551 | CPT | MRI brain (including brain stem); without contrast material |
| 70552 | CPT | MRI brain; with contrast material(s) |
| 70553 | CPT | MRI brain; without contrast, followed by contrast and further sequences |
| 82565 | CPT | Creatinine; blood |
| 82947 | CPT | Glucose; quantitative, blood |
| 84443 | CPT | Thyroid stimulating hormone (TSH) |
| 84520 | CPT | Urea nitrogen; quantitative |
| 85014 | CPT | Blood count; hematocrit (Hct) |
| 85018 | CPT | Blood count; hemoglobin (Hgb) |
| 85032 | CPT | Manual cell count (erythrocyte, leukocyte, or platelet), each |
| 85048 | CPT | Leukocyte (WBC), automated |
| 85651 | CPT | Sedimentation rate, erythrocyte; non-automated |
| 85652 | CPT | Sedimentation rate, erythrocyte; automated |
| 86003 | CPT | Allergen specific IgE; quantitative or semiquantitative, each allergen |
| 80150–80199 | CPT | Therapeutic drug assays (full range) — when medication or nutritional deficiency is suspected cause |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 70540 | CPT | MRI orbit, face, and/or neck; without contrast | Not covered for smell/taste diagnosis |
| 70542 | CPT | MRI orbit, face, and/or neck; with contrast | Not covered for smell/taste diagnosis |
| 70543 | CPT | MRI orbit, face, and/or neck; without contrast followed by contrast | Not covered for smell/taste diagnosis |
| 78267 | CPT | Urea breath test, C-14; acquisition for analysis (H. pylori) | Not covered for this indication |
| 78268 | CPT | Urea breath test, C-14; analysis (H. pylori) | Not covered for this indication |
| 78608 | CPT | Brain PET; metabolic evaluation | Not covered for smell/taste diagnosis |
| 83013 | CPT | H. pylori; breath test analysis for urease activity, non-radioactive isotope (C-13) | Not covered for this indication |
| 83014 | CPT | H. pylori; drug administration | Not covered for this indication |
| 87338 | CPT | H. pylori antigen detection by immunoassay | Not covered for this indication |
| 92512 | CPT | Nasal function studies (e.g., rhinomanometry) | Excluded under CPB 0390 |
| 95012 | CPT | Nitric oxide expired gas determination | Not covered for smell/taste diagnosis |
Key ICD-10-CM Diagnosis Codes
The policy data does not list specific ICD-10-CM codes. Clinically relevant codes for billing context include anosmia (R43.0), hyposmia (R43.1), parosmia (R43.2), and unspecified taste and smell disturbance (R43.9) — but confirm these against your Aetna contract and the full CPB 0390 policy document, as no ICD-10 codes were specified in the published policy data.
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