TL;DR: Aetna, a CVS Health company, modified CPB 0416 covering nerve grafting and reconstruction, effective September 26, 2025. Billing teams working with CPT codes 64911, 64912, 64913, 0882T, and 0883T — plus prostatectomy codes 55840 through 55866 — need to review how this coverage policy change affects their charge capture and claim submissions before that date.
CPB 0416 Aetna governs selected indications for nerve grafting, nerve repair, and nerve reconstruction procedures. This update touches a wide range of specialties — urology, neurosurgery, orthopedic surgery, and plastic surgery among them. The policy also calls out four HCPCS codes (C9352, C9353, C9355, C9361) as explicitly not covered for the indications listed in this bulletin.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Nerve Grafting and Reconstruction: Selected Indications |
| Policy Code | CPB 0416 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium-High |
| Specialties Affected | Urology, Neurosurgery, Orthopedic Surgery, Plastic/Reconstructive Surgery |
| Key Action | Audit charge capture for CPT 64911–64913, 0882T, 0883T, and prostatectomy codes 55840–55866 before September 26, 2025 |
Aetna Nerve Grafting Coverage Criteria and Medical Necessity Requirements 2025
The Aetna nerve grafting coverage policy under CPB 0416 covers selected indications for nerve repair and reconstruction — not all peripheral nerve procedures automatically qualify. Medical necessity is the threshold Aetna will hold your claims to, and the policy groups covered procedures around several distinct clinical scenarios.
The core covered territory includes nerve repairs using autogenous vein grafts (CPT 64911), nerve allografts for the first strand (CPT 64912), and each additional allograft strand (CPT 64913). Intraoperative therapeutic electrical stimulation using CPT 0882T and 0883T also falls within the policy's scope for sural nerve, cavernous nerve, and genitofemoral graft procedures — though these two Category III codes carry no specific coverage designation in the current policy language, which means prior authorization and clinical documentation are critical before submitting.
The prostatectomy codes — CPT 55840, 55842, 55845, and 55866 — appear as related codes in this policy. They connect to the post-prostatectomy erectile dysfunction indication, which Aetna maps to ICD-10-CM codes N52.1 through N52.9. If your practice bills nerve-sparing radical prostatectomy procedures and separately bills associated nerve grafting, this coverage policy directly governs how Aetna will adjudicate those reconstruction claims.
Medical necessity documentation for nerve repair procedures should address the specific nerve injured or affected, the clinical rationale for graft type selection, and — for post-prostatectomy cases — the causal relationship between the procedure and the erectile dysfunction diagnosis. Weak documentation on any of these points is a direct path to a claim denial.
Bell's Palsy (G51.0), mononeuropathies and compression neuropathies (G57.00–G58.9), diaphragmatic paralysis (J98.6), and traumatic nerve injuries at the shoulder/upper arm (S44.90XA–S44.92XS), forearm (S54.90XA–S54.92XS), and wrist/hand (S64.90XA–S64.92XS) levels round out the covered diagnosis indications. Each of these diagnoses pairs with specific repair procedures — you should not submit a nerve allograft claim (CPT 64912) for a Bell's Palsy diagnosis without clinical documentation justifying why allograft was medically necessary versus other repair approaches.
Check whether your Aetna contract or plan type requires prior authorization for these procedure codes. Outpatient surgical nerve repair under CPT 64911–64913 frequently triggers PA requirements under commercial Aetna plans, and submitting without prior authorization when it's required is the fastest route to a denial you won't recover.
Aetna Nerve Grafting Exclusions and Non-Covered Indications
The four HCPCS codes in this policy are flatly not covered for the indications listed in CPB 0416. These are collagen-based nerve guide and wrap products:
| # | Excluded Procedure |
|---|---|
| 1 | C9352 — Neuragen Nerve Guide (microporous collagen implantable tube), per centimeter |
| 2 | C9353 — Neurawrap Nerve Protector (microporous collagen implantable slit tube), per centimeter |
| 3 | C9355 — Neuromatrix collagen nerve cuff, per 0.5 centimeter |
| 4 | C9361 — Neuromend Collagen Nerve Wrap, per 0.5 centimeter |
Aetna's position on these products is clear: non-covered. Billing any of these HCPCS codes expecting reimbursement from Aetna for the indications in CPB 0416 will result in denial. If your surgeons use these products, make sure you have Advance Beneficiary Notice-equivalent documentation and patient financial counseling in place before the procedure — not after the claim bounces.
This is a meaningful exclusion for practices that use nerve conduit products routinely in peripheral nerve repair. Collagen nerve wraps and guides have been a contested coverage area across payers for years. Aetna's position here mirrors what several other commercial payers have held: the clinical evidence supporting these devices over conventional nerve repair techniques isn't strong enough to warrant coverage. Whether you agree with that clinical judgment or not, the billing reality is that you won't collect from Aetna on C9352, C9353, C9355, or C9361 under this policy.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Nerve repair with autogenous vein graft | Covered (when medically necessary) | CPT 64911 | Documentation of nerve injury and graft rationale required |
| Nerve repair with allograft — first strand | Covered (when medically necessary) | CPT 64912 | Prior auth likely required; confirm per plan |
| Nerve repair with allograft — additional strands | Covered (when medically necessary) | CPT 64913 | Bill as add-on to 64912; confirm surgical report documents each strand |
| Intraoperative therapeutic electrical stimulation — sural/cavernous/genitofemoral | No specific coverage designation | CPT 0882T, 0883T | Category III codes; verify coverage pre-procedure; high denial risk without prior auth |
| Post-prostatectomy erectile dysfunction nerve reconstruction | Covered (when medically necessary) | CPT 55840, 55842, 55845, 55866; ICD-10 N52.1–N52.9 | Must establish causal link to prostatectomy |
| Bell's Palsy nerve procedures | Covered (when medically necessary) | ICD-10 G51.0 | Clinical documentation must support surgical intervention |
| Mononeuropathy/compression neuropathy | Covered (when medically necessary) | ICD-10 G57.00–G58.9 | Confirm conservative treatment failure is documented |
| Diaphragmatic paralysis | Covered (when medically necessary) | ICD-10 J98.6 | Less common indication; ensure clear diagnosis coding |
| Traumatic nerve injuries (shoulder/upper arm, forearm, wrist/hand) | Covered (when medically necessary) | ICD-10 S44.90XA–S44.92XS, S54.90XA–S54.92XS, S64.90XA–S64.92XS | Trauma documentation and laterality coding critical |
| Collagen nerve guides and wraps (Neuragen, Neurawrap, Neuromatrix, Neuromend) | Not Covered | HCPCS C9352, C9353, C9355, C9361 | Explicitly excluded for CPB 0416 indications |
Aetna Nerve Grafting Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 64911, 64912, and 64913 before September 26, 2025. Confirm that every nerve repair claim includes the paired ICD-10 diagnosis from the covered list above. A claim for CPT 64912 with an unspecified or unsupported diagnosis code will deny on medical necessity grounds. |
| 2 | Pull every CPT 0882T and 0883T claim from the past 12 months and check your Aetna denial rate. These Category III intraoperative electrical stimulation codes carry no specific coverage designation in CPB 0416. That ambiguity is a red flag. Contact your Aetna provider representative and get written confirmation of coverage before billing these codes again after the September 26, 2025 effective date. |
| 3 | Remove HCPCS C9352, C9353, C9355, and C9361 from your Aetna charge capture for covered indications immediately. There is no coverage pathway for these collagen nerve products under CPB 0416. If your surgeons use these devices, set up a patient responsibility workflow so the cost discussion happens before the OR — not after. |
| 4 | For post-prostatectomy erectile dysfunction cases billed under N52.1–N52.9, verify that the operative report explicitly documents cavernous nerve involvement and reconstruction. Aetna will look for clinical justification linking the prostatectomy (CPT 55840, 55842, 55845, or 55866) to the nerve reconstruction procedure. Vague operative notes are a direct path to a medical necessity denial. |
| 5 | Confirm prior authorization requirements for CPT 64911–64913 across your Aetna plan types before the effective date. PA requirements vary by product — commercial HMO plans almost always require it; PPO plans may not. Don't assume. Call your Aetna provider relations contact or pull the PA requirement list from your provider portal. Submit PA requests with clinical documentation that addresses the specific nerve, the injury or condition, and the rationale for autograft versus allograft. |
| 6 | Check laterality and episode coding on all traumatic nerve injury claims. The ICD-10 ranges for shoulder/upper arm (S44.90XA–S44.92XS), forearm (S54.90XA–S54.92XS), and wrist/hand (S64.90XA–S64.92XS) have episode-of-care suffixes. Initial encounter (A), subsequent encounter (D), and sequela (S) designations matter for claim processing. An incorrect suffix on a nerve repair claim raises a flag. |
| 7 | Talk to your compliance officer if your practice bills nerve repair alongside robotic prostatectomy (CPT 55866). The combination of a high-dollar surgical procedure code with an associated nerve reconstruction claim in the same episode draws scrutiny. Your compliance officer should review your documentation standards for these combined cases before the policy takes effect. |
| 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 Nerve Grafting and Reconstruction Under CPB 0416
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 64911 | CPT | Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve |
| 64912 | CPT | Nerve repair; with nerve allograft, each nerve, first strand (cable) |
| 64913 | CPT | Nerve repair; with nerve allograft, each additional strand (List separately in addition to code for primary procedure) |
CPT Codes With No Specific Coverage Designation (Verify Before Billing)
| Code | Type | Description | Notes |
|---|---|---|---|
| 0882T | CPT | Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration (first nerve) | Category III; no specific coverage designation in CPB 0416 |
| 0883T | CPT | Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration (each additional nerve) | Category III; no specific coverage designation in CPB 0416 |
Other CPT Codes Related to CPB 0416 (Prostatectomy)
| Code | Type | Description |
|---|---|---|
| 55840 | CPT | Prostatectomy, retropubic radical, with or without nerve sparing |
| 55842 | CPT | Prostatectomy, retropubic radical, with lymph node biopsy(s) (limited pelvic lymphadenectomy) |
| 55845 | CPT | Prostatectomy, retropubic radical, with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes |
| 55866 | CPT | Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance |
Not Covered HCPCS Codes (Collagen Nerve Products)
| Code | Type | Description | Reason |
|---|---|---|---|
| C9352 | HCPCS | Microporous collagen implantable tube (Neuragen Nerve Guide), per centimeter length | Not covered for indications listed in CPB 0416 |
| C9353 | HCPCS | Microporous collagen implantable slit tube (Neurawrap Nerve Protector), per centimeter length | Not covered for indications listed in CPB 0416 |
| C9355 | HCPCS | Collagen nerve cuff (Neuromatrix), per 0.5 centimeter length | Not covered for indications listed in CPB 0416 |
| C9361 | HCPCS | Collagen matrix nerve wrap (Neuromend Collagen Nerve Wrap), per 0.5 centimeter length | Not covered for indications listed in CPB 0416 |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| G51.0 | Bell's Palsy |
| G57.00–G58.9 | Mononeuropathy/Compression Neuropathy |
| J98.6 | Disorders of diaphragm (Diaphragmatic Paralysis) |
| N52.1–N52.9 | Male erectile dysfunction (status post radical retropubic prostatectomy) |
| S44.90XA–S44.92XS | Injury of unspecified nerve at shoulder and upper arm level, unspecified arm |
| S54.90XA–S54.92XS | Injury of unspecified nerve at forearm level, unspecified arm |
| S64.90XA–S64.92XS | Injury of unspecified nerve at wrist and hand level of unspecified arm |
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