TL;DR: Aetna, a CVS Health company, modified CPB 0394 governing epilepsy surgery coverage, effective September 26, 2025. Here's what billing teams need to know before submitting claims.
This update to the Aetna epilepsy surgery coverage policy touches a wide range of CPT codes — from craniotomy procedures like 61534 and 61536 to neurostimulator implantation codes like 61863 and 61885, to stereotactic radiosurgery codes like 61796 and 77371. CPB 0394 Aetna is one of the more code-dense neurology policies on the books, covering 52 CPT codes and 31 HCPCS codes across surgical, radiation, and device categories. If your practice bills for epilepsy surgery, neuromodulation, or intraoperative neurophysiology monitoring, this policy affects your reimbursement.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Epilepsy Surgery — CPB 0394 |
| Policy Code | CPB 0394 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Neurosurgery, Neurology, Radiation Oncology, Clinical Neurophysiology, Epileptology |
| Key Action | Audit your charge capture for all covered and non-covered codes against the updated criteria before submitting claims dated on or after September 26, 2025 |
Aetna Epilepsy Surgery Coverage Criteria and Medical Necessity Requirements 2025
The Aetna epilepsy surgery coverage policy under CPB 0394 covers a broad set of surgical and neuromodulation interventions — but only when all selection criteria are met. That word "all" is doing a lot of work. Aetna does not use an "any one of" threshold here. Every medical necessity criterion must be satisfied before a procedure clears for coverage.
The policy covers procedures in several major categories: open resective surgery (CPT 61534, 61536, 61537, 61538, 61541, 61543, 61566), laser interstitial thermal therapy or LITT (CPT 61736, 61737), stereotactic radiosurgery (CPT 61796, 61797, 61798, 61799, 61800), and neurostimulator implantation (CPT 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891). Device management codes including 95970, 95971, 95976, 95977, 95983, and 95984 are also covered when criteria are met.
Prior authorization is almost certainly required for procedures in this category given Aetna's standard practices for surgical and implantable device coverage. Confirm prior auth requirements for each specific procedure type before scheduling — especially for neurostimulator implantations and stereotactic radiosurgery, where the device and facility costs create high financial exposure if a claim denial follows.
The Wada activation test (CPT 95958) and electrocorticogram from an implanted pulse generator (CPT 95836) are both listed as covered when selection criteria are met. These are often billed alongside surgical procedures, so your charge capture needs to reflect both the primary surgical code and any adjunct monitoring codes.
Aetna Epilepsy Surgery Exclusions and Non-Covered Indications
This is where billing teams lose money. Aetna explicitly designates several codes as not covered for the indications listed in CPB 0394.
Epicranial neurostimulator system procedures — CPT 0968T (insertion or replacement) and 0969T (removal) — are not covered. These are Category III codes representing an emerging neurostimulation approach, and Aetna's position is that they do not meet medical necessity standards for this policy.
Several HCPCS codes are also not covered under this policy. E0733 (transcutaneous electrical nerve stimulator for trigeminal nerve stimulation) and its monthly supply code A4541 are both excluded. The related stem cell and bone marrow codes — S2142 and S2150 — are not covered here either, which matters if you're billing a complex case where those codes appeared on the claim.
The HCPCS codes for implantable neurostimulator components — L8680, L8681, L8682, L8683, L8685, L8688, L8689, L8695 — are listed as not covered for indications in this CPB. This is a critical distinction. C1767 (non-rechargeable neurostimulator generator) and L8687 (dual array, rechargeable) are covered. Bill the wrong device HCPCS code and you'll get a denial regardless of whether the surgery itself was covered.
G0453 (continuous intraoperative neurophysiology monitoring, remote) is also listed as not covered. This is where things get confusing — the policy covers +95941 for the same remote monitoring service under the CPT coding system. If your facility uses G0453 on the HCPCS side, expect a denial under this policy. Use +95941 instead.
Robotic surgical assistance (S2900) is not covered under this CPB.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Resective epilepsy surgery (excision of epileptogenic focus) | Covered | CPT 61534, 61536 | All selection criteria must be met |
| Temporal lobectomy | Covered | CPT 61537, 61538 | With or without electrocorticography variants |
| Corpus callosotomy | Covered | CPT 61541 | Selection criteria required |
| Hemispherectomy (partial or subtotal) | Covered | CPT 61543 | Selection criteria required |
| Selective amygdalohippocampectomy | Covered | CPT 61566 | Selection criteria required |
| Multiple subpial transections with electrocorticography | Covered | CPT 61567 | Selection criteria required |
| LITT — single trajectory | Covered | CPT 61736 | Includes MRI guidance |
| LITT — multiple trajectories | Covered | CPT 61737 | Complex/multiple lesions |
| Stereotactic radiosurgery (1 simple cranial lesion) | Covered | CPT 61796, 77371, 77372 | Selection criteria required |
| Stereotactic radiosurgery (complex lesions) | Covered | CPT 61798, 61799, 77432, 77435 | Selection criteria required |
| Neurostimulator electrode implantation (cortical) | Covered | CPT 61850, 61860 | Selection criteria required |
| Neurostimulator electrode implantation (stereotactic) | Covered | CPT 61863, 61864, 61867, 61868 | Selection criteria required |
| Neurostimulator pulse generator insertion/replacement | Covered | CPT 61885, 61886, 61889 | Selection criteria required |
| Neurostimulator revision/removal | Covered | CPT 61880, 61888, 61891 | Intractable seizures noted for 61880 |
| Vagus nerve stimulation (cranial nerve) | Covered | CPT 64553 | Selection criteria required |
| Peripheral nerve electrode with integrated neurostimulator | Covered | CPT 64596, 64597 | Selection criteria required |
| Wada activation test | Covered | CPT 95958 | Selection criteria required |
| Electrocorticogram from implanted pulse generator | Covered | CPT 95836 | Selection criteria required |
| Neurostimulator electronic analysis | Covered | CPT 95970, 95971, 95976, 95977, 95983, 95984 | Selection criteria required |
| Intraoperative neurophysiology monitoring (in OR) | Covered | CPT +95940 | AI group designation |
| Intraoperative neurophysiology monitoring (remote) | Covered | CPT +95941 | Use +95941, NOT G0453 |
| Image-guided robotic linear accelerator SRS | Covered | HCPCS G0339, G0340 | Selection criteria required |
| Non-rechargeable neurostimulator generator | Covered | HCPCS C1767 | Selection criteria required |
| Rechargeable dual-array pulse generator | Covered | HCPCS L8687 | Selection criteria required |
| Epicranial neurostimulator insertion/removal | Not Covered | CPT 0968T, 0969T | Not covered for indications in CPB |
| Trigeminal nerve TENS device | Not Covered | HCPCS E0733, A4541 | Not covered for indications in CPB |
| Implantable neurostimulator components (L-codes) | Not Covered | HCPCS L8680–L8695 (multiple) | Use C1767 or L8687 instead where applicable |
| Remote intraoperative monitoring (HCPCS) | Not Covered | HCPCS G0453 | Use CPT +95941 instead |
| Robotic surgical assistance | Not Covered | HCPCS S2900 | Not covered for indications in CPB |
| Stem cell/bone marrow codes | Not Covered | HCPCS S2142, S2150 | Not covered for indications in CPB |
| Functional cortical/subcortical mapping | Related | CPT 95961, 95962 | Listed as related to CPB — verify coverage separately |
Aetna Epilepsy Surgery Billing Guidelines and Action Items 2025
Here are the specific steps your billing team needs to take before submitting claims under this updated coverage policy.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for neurostimulator HCPCS codes immediately. The L-code split is the highest denial risk in this policy. C1767 and L8687 are covered. L8680, L8681, L8682, L8683, L8685, L8688, L8689, and L8695 are not covered under CPB 0394. If your CDM or charge capture templates default to any of those non-covered L-codes for epilepsy surgery cases, fix them before September 26, 2025. |
| 2 | Replace G0453 with CPT +95941 for remote intraoperative monitoring on Aetna epilepsy claims. G0453 is explicitly not covered under this CPB. CPT +95941 covers the same remote monitoring service. This one substitution will prevent a predictable claim denial with no clinical reconsideration needed. |
| 3 | Confirm prior authorization requirements for every surgical category in this policy. Craniotomy, LITT, stereotactic radiosurgery, and neurostimulator implantation all carry high cost and complexity. Aetna epilepsy surgery reimbursement depends on meeting all selection criteria — which means prior auth documentation needs to reflect every criterion, not just the primary diagnosis. Get this right before scheduling. |
| 4 | Flag 0968T and 0969T in your billing system as non-covered for Aetna epilepsy cases. Epicranial neurostimulator procedures are explicitly excluded. If your neurosurgery team is doing any epicranial work, those cases need a separate coverage review — CPB 0394 does not cover them. |
| 5 | Update your medical necessity documentation templates to reflect the "all criteria must be met" standard. This policy uses conjunctive criteria, not disjunctive. Your clinical documentation needs to address every requirement. One missing criterion is enough for a denial. Work with your medical director to build a checklist that maps directly to CPB 0394's criteria before the effective date. |
| 6 | Verify billing guidelines for bone marrow and stem cell codes if they appear in complex cases. CPT codes 38232, 38240, 38241, and 38242 appear in this policy under an AI (artificial intelligence convolutional neural network) group designation. HCPCS S2142 and S2150 are not covered. If your facility bills bone marrow or stem cell procedures alongside epilepsy surgery, talk to your compliance officer about how those claims should be structured under this CPB. |
| 7 | Check CPT 95961 and 95962 coverage separately. Functional cortical and subcortical mapping codes are listed as "other CPT codes related to the CPB" — not explicitly covered, not explicitly excluded. That ambiguity means you need to verify coverage for each claim. Do not assume they're covered because they appear in the policy. |
| 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 Epilepsy Surgery Under CPB 0394
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 61534 | CPT | Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography |
| 61536 | CPT | Craniotomy for excision of epileptic focus, with electrocorticography during surgery |
| 61537 | CPT | Craniotomy for lobectomy, temporal lobe, without electrocorticography during surgery |
| 61538 | CPT | Craniotomy for lobectomy with electrocorticography during surgery, temporal lobe |
| 61541 | CPT | Craniotomy for transection of corpus callosum |
| 61543 | CPT | Craniotomy for partial or subtotal hemispherectomy |
| 61566 | CPT | Craniotomy for selective amygdalohippocampectomy |
| 61567 | CPT | Craniotomy for multiple subpial transections, with electrocorticography |
| 61736 | CPT | Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with MRI guidance |
| 61737 | CPT | LITT, multiple trajectories for multiple or complex lesion(s) |
| 61796 | CPT | Stereotactic radiosurgery; 1 simple cranial lesion |
| 61797 | CPT | Stereotactic radiosurgery; each additional cranial lesion, simple (add-on) |
| 61798 | CPT | Stereotactic radiosurgery; 1 complex cranial lesion |
| 61799 | CPT | Stereotactic radiosurgery; each additional cranial lesion, complex (add-on) |
| 61800 | CPT | Application of stereotactic headframe for stereotactic radiosurgery (add-on) |
| 61850 | CPT | Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical |
| 61860 | CPT | Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical |
| 61863 | CPT | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array |
| 61864 | CPT | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array (additional) |
| 61867 | CPT | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array |
| 61868 | CPT | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array (additional) |
| 61880 | CPT | Revision or removal of intracranial neurostimulator electrodes (covered for intractable seizures) |
| 61885 | CPT | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling |
| 61886 | CPT | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling |
| 61888 | CPT | Revision or removal of cranial neurostimulator pulse generator or receiver |
| 61889 | CPT | Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy |
| 61891 | CPT | Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver |
| 64553 | CPT | Percutaneous implantation of neurostimulator electrode array; cranial nerve |
| 64596 | CPT | Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator |
| 64597 | CPT | Each additional electrode array (add-on) |
| 77371 | CPT | Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) |
| 77372 | CPT | SRS, linear accelerator based |
| 77432 | CPT | Stereotactic radiation treatment management of cranial lesion(s), complete course |
| 77435 | CPT | Stereotactic body radiation therapy, treatment management, per treatment course |
| 95836 | CPT | Electrocorticogram from implanted brain neurostimulator pulse generator/transmitter, including review |
| 95958 | CPT | Wada activation test for hemispheric function, including EEG monitoring |
| 95970 | CPT | Electronic analysis of implanted neurostimulator pulse generator system |
| 95971 | CPT | Electronic analysis of implanted neurostimulator pulse generator system (simple) |
| 95976 | CPT | Electronic analysis of implanted neurostimulator pulse generator/transmitter |
| 95977 | CPT | Electronic analysis of implanted neurostimulator pulse generator/transmitter (subsequent) |
| 95983 | CPT | Electronic analysis of implanted neurostimulator pulse generator/transmitter |
| 95984 | CPT | Electronic analysis of implanted neurostimulator pulse generator/transmitter (subsequent) |
| +95940 | CPT | Continuous intraoperative neurophysiology monitoring in the operating room, one on one |
| +95941 | CPT | Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote) |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0968T | CPT | Insertion or replacement of epicranial neurostimulator system, including electrode array and pulse generator | Not covered for indications in CPB 0394 |
| 0969T | CPT | Removal of epicranial neurostimulator system | Not covered for indications in CPB 0394 |
| E0733 | HCPCS | Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve | Not covered for indications in CPB 0394 |
| A4541 | HCPCS | Monthly supplies for use of device coded at E0733 | Not covered for indications in CPB 0394 |
| G0453 | HCPCS | Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote) — HCPCS version | Not covered; use CPT +95941 instead |
| L8680 | HCPCS | Implantable neurostimulator electrode, each | Not covered for indications in CPB 0394 |
| L8681 | HCPCS | Patient programmer (external) for use with implantable programmable neurostimulator pulse generator | Not covered for indications in CPB 0394 |
| L8682 | HCPCS | Implantable neurostimulator radiofrequency receiver | Not covered for indications in CPB 0394 |
| L8683 | HCPCS | Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver | Not covered for indications in CPB 0394 |
| L8685 | HCPCS | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension | Not covered for indications in CPB 0394 |
| L8688 | HCPCS | Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension | Not covered for indications in CPB 0394 |
| L8689 | HCPCS | External recharging system for battery (internal) for use with implantable neurostimulator | Not covered for indications in CPB 0394 |
| L8695 | HCPCS | External recharging system for battery (external) for use with implantable neurostimulator | Not covered for indications in CPB 0394 |
| S2142 | HCPCS | Cord blood-derived stem cell transplantation, allogeneic | Not covered for indications in CPB 0394 |
| S2150 | HCPCS | Bone marrow or blood-derived stem cells, allogeneic or autologous, harvesting | Not covered for indications in CPB 0394 |
| S2900 | HCPCS | Surgical techniques requiring use of robotic surgical system | Not covered for indications in CPB 0394 |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| C1767 | HCPCS | Generator, neurostimulator (implantable), non-rechargeable |
| L8687 | HCPCS | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension |
| G0339 | HCPCS | Image guided robotic linear accelerator-based stereotactic radiosurgery, complete course |
| G0340 | HCPCS | Image guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimation |
Key ICD-10-CM Diagnosis Codes
The policy data for CPB 0394 does not include a published list of ICD-10-CM diagnosis codes. Verify diagnosis code requirements directly in the full policy document or with your Aetna provider representative before claim submission.
Get the Full Picture for CPT 61534
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.