Aetna CPB 0438 Updated: 43 CPT Codes and 7 HCPCS Codes Designated as Obsolete or Unreliable — What Billing Teams Need to Know

Aetna, a CVS Health company, modified CPB 0438 — its policy on obsolete and unreliable tests and procedures — effective September 26, 2025. This update affects 43 CPT codes and seven HCPCS codes across surgical, diagnostic, and procedural categories, and it has real claim denial exposure for billing teams that haven't audited their charge capture against this list.

If your practice bills colectomy codes (44139–44213), optic nerve decompression (67570), osteopathic manipulative treatment (98925), or any of a dozen legacy diagnostic codes, review this now. The CPB 0438 Aetna system designation blocks reimbursement for these codes under the indications listed in the policy. There is no prior authorization pathway that unlocks coverage for procedures classified as obsolete.

Quick-Reference Table

Aetna Obsolete and Unreliable Tests Coverage Policy: Medical Necessity Requirements 2025

The core of Aetna's coverage policy under CPB 0438 is straightforward: procedures and tests classified as obsolete or unreliable do not meet medical necessity criteria. Full stop.

Aetna's clinical reviewers do not evaluate these codes for case-by-case medical necessity. The designation itself ends the coverage determination. That means prior authorization requests won't help you here — prior auth is a coverage pathway, and there's no coverage to authorize.

The policy splits codes into two groups. The first group — which includes the bulk of the surgical codes — is designated as "not covered for indications listed in the CPB." The second group ties specific codes to the Lupus erythematosus (LE) cell test or the LE Cell Phenomenon, an outdated diagnostic approach that Aetna considers superseded by more reliable testing.

The LE cell test group includes a mix of lab codes and surgical procedures that have been displaced by modern diagnostics. CPT 85547 (mechanical fragility, RBC) and CPT 0123U (mechanical fragility, RBC, shear stress and spectral analysis profiling) both appear here. So does CPT 82024 (adrenocorticotropic hormone, animal tests), CPT 82150 (amylase, electrophoretic), CPT 82495 (chromium, blood), and CPT 82965 (glutamate dehydrogenase, serum). These are tests your lab may still run — but Aetna will not pay for them under these indications.

Aetna Obsolete Procedure Exclusions and Non-Covered Indications

Every code in CPB 0438 is a non-covered designation. There are no covered exceptions within this policy. The question for your billing team is whether you're billing any of these codes for Aetna members and expecting reimbursement.

The colectomy code range is the biggest exposure for surgical practices. CPT codes 44139 through 44213 cover partial and total colectomies across open and laparoscopic approaches. This is a wide range. If your colorectal surgery team bills Aetna, check whether any of these codes appear on your standard charge master without a coverage flag.

CPT 67570 — optic nerve decompression — appears in the surgical exclusion group. This procedure has been considered obsolete for ischemic optic neuropathy for years, and the ICD-10 codes H47.11 through H47.19 for ischemic optic neuropathy appear in the policy's diagnosis code list. If your ophthalmology team is billing 67570 for those diagnoses, expect denial.

CPT 77401 (superficial radiation treatment delivery) and CPT 98925 (osteopathic manipulative treatment, one to two body regions) are also explicitly excluded. OMT billing is already complex under commercial payers — CPB 0438 removes any ambiguity about 98925 for Aetna under the listed indications.

On the HCPCS side, M0100 (intragastric hypothermia using gastric freezing) and S9025 (omnicardiogram/cardiointegram) are exactly what they sound like — procedures that haven't been in routine clinical use for decades but still appear in some billing systems. HCPCS codes P2028, P2029, P2033, and P2038 cover antiquated blood chemistry panels. J9165 (diethylstilbestrol diphosphate injection) rounds out the HCPCS list.

The real issue here isn't that these procedures are being done routinely. It's that these codes can appear on bills through miscoding, legacy charge master entries, or outdated order sets. A claim denial on a colectomy because the wrong CPT variant was selected is an expensive and avoidable problem.

Coverage Indications at a Glance

Aetna Obsolete Tests and Procedures Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Obsolete and Unreliable Tests and Procedures Under CPB 0438

CPT Codes Not Covered for Indications Listed in CPB 0438

CPT Codes Not Covered — LE Cell Test / LE Cell Phenomenon Indications

HCPCS Codes Not Covered Under CPB 0438

Key ICD-10-CM Diagnosis Codes Referenced in CPB 0438

The full ICD-10-CM list in CPB 0438 includes 158 codes. Review the complete policy at app.payerpolicy.org/p/aetna/0438 for the full diagnosis code set.