Smell and Taste Disorders - Diagnosis — CPB 0390 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0390 governing smell and taste disorder evaluations, effective September 26, 2025. Billing teams need to audit documentation and visit counts before submitting claims for olfactory and gustatory dysfunction workups.

Aetna's updated smell and taste disorders coverage policy under CPB 0390 clarifies which diagnostic services meet medical necessity for anosmia, hyposmia, dysosmia, ageusia, hypogeusia, and dysgeusia. The policy covers a defined set of evaluation services — including nasal endoscopy (CPT 31231), neuroimaging via CT (CPT 70450–70470) and MRI (CPT 70551–70553), standardized olfactory testing, and a broad panel of lab codes (CPT 82565, 82947, 84443, 84520, 85014, 85018, 85032, 85048, 85651, 85652, 86003) — but draws a hard line on visit frequency. If your practice bills ENT, neurology, or otolaryngology services for Aetna members, this policy update belongs on your team's radar before October 1.

---

Quick-Reference Table

Field	Detail Copy
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, Neurology, Psychiatry, Primary Care, Clinical Laboratory
Key Action	Audit visit counts and documentation for smell/taste disorder workups; limit testing visits to one initial and one follow-up

---

Aetna Smell and Taste Disorder Coverage Criteria and Medical Necessity Requirements 2025

CPB 0390 establishes that Aetna considers diagnostic evaluation services medically necessary for members with unexplained olfactory dysfunction (anosmia, hyposmia, dysosmia) or gustatory dysfunction (ageusia, hypogeusia, dysgeusia). The word "unexplained" is doing real work here. Your documentation must show the underlying cause is not yet established — this isn't a coverage policy for routine follow-up once a diagnosis is confirmed.

The policy lays out 13 categories of covered services. Read them as a defined menu, not an open buffet. Aetna expects the workup to match the clinical picture, and billing outside the justified path will generate a claim denial.

Here's what Aetna will cover when medical necessity criteria are met:

Complete medical evaluation — a full history and physical examination is the baseline. Every workup starts here. Document it thoroughly.

Standardized olfactory testing — this includes the University of Pennsylvania Smell Identification Test (UPSIT), "Sniffin' Sticks," the University of Connecticut Test Battery, the Pocket Smell Test, the Brief Smell Identification Test, plus Smell-Threshold, Smell-Suprathreshold, and Smell Unilateral tests. If your practice uses a proprietary smell test not on this list, expect scrutiny.

Standard taste tests — Taste-Threshold (Whole-Mouth), Taste-Suprathreshold, Taste-Quadrant, and Flavor Discrimination tests are covered. Aetna also notes that members with taste loss may need smell testing in addition to taste testing. Bill accordingly and document why both were ordered.

Neuroimaging — CT (CPT 70450, 70460, 70470, 70496) and MRI (CPT 70551, 70552, 70553) are covered to rule out intracranial or peripheral nerve abnormality. The indication has to be in the record. "Patient has anosmia" alone isn't enough — document the clinical reasoning for imaging.

Nasal endoscopy — CPT 31231 is covered. This is a separate procedure code; confirm it's not bundled against other services on the same claim.

Consultations — neurological, otolaryngological, and psychiatric consultations are all covered when clinically indicated.

Lab work — Aetna covers a specific panel: hematocrit (CPT 85014), hemoglobin (CPT 85018), manual cell count (CPT 85032), WBC automated (CPT 85048), erythrocyte sedimentation rate (CPT 85651, 85652), IgE (CPT 86003), creatinine (CPT 82565), glucose (CPT 82947), urea nitrogen (CPT 84520), and thyroid stimulating hormone (CPT 84443). Drug assays (CPT 80150–80199 range) are covered when medication or nutritional deficiency is the suspected cause.

EEG — covered specifically for members with a history of seizures. If there's no seizure history in the record, don't expect reimbursement.

Olfactory mucosa biopsy — CPT 30100 is covered when criteria are met. This is a low-volume code in this context, but it needs strong clinical justification in the documentation.

Note: CPB 0390 does not address prior authorization. Check Aetna's plan-level authorization requirements independently, as they vary by plan and are not governed by this CPB. This applies to imaging services such as CPT 70450–70470 and CPT 70551–70553, among others.

---

Aetna Smell and Taste Disorder Exclusions and Non-Covered Indications

Several codes sit in a "not covered" bucket under this policy. Aetna explicitly excludes:

The real issue here is that some of these codes feel intuitive for a sinonasal workup. Rhinomanometry seems like a reasonable add-on to nasal endoscopy. Aetna disagrees. Bill any of these codes for a smell/taste disorder evaluation and you're looking at a denial.

The visit frequency limit is the other critical exclusion. Aetna considers one initial visit and one follow-up visit medically necessary for smell and taste dysfunction testing. Additional testing visits are not medically necessary. If your workflow involves three or four diagnostic visits before a final assessment, you need to restructure it for Aetna members or document an exceptional clinical reason for each additional encounter — and even then, expect pushback.

---

Coverage Indications at a Glance

---

Aetna Smell and Taste Disorder Billing Guidelines and Action Items 2025

The effective date of September 26, 2025 is already here. If your practice bills smell and taste disorder evaluations for Aetna members, these steps need to happen now.

Copy Action Items

If your practice has high Aetna volume in ENT or neurology, loop in your compliance officer before processing the first batch of claims under this updated policy. The visit frequency limit, in particular, creates retroactive denial risk if your billing team doesn't flag it at the point of service.

---

CPT, HCPCS, and ICD-10 Codes for Smell and Taste Disorders Under CPB 0390

Covered CPT Codes (When Selection Criteria Are Met)

Therapeutic Drug Assay Codes (Covered When Medication or Nutritional Deficiency Is Suspected)

Code	Type	Description Copy
80150–80199	CPT	Therapeutic drug assays (CPT 80150 through 80199 range)

Note: The full range of therapeutic drug assay codes (80150–80199) is listed in the policy. Bill only the specific assay code matching the drug being tested.

Not Covered / Experimental Codes

ICD-10-CM Diagnosis Codes

The source policy data for CPB 0390 does not enumerate specific ICD-10-CM diagnosis codes. Consult your coding team and Aetna's claims adjudication requirements to determine appropriate diagnosis codes for olfactory and gustatory dysfunction claims.

---