Contact Dissolution for Gallstones — CPB 0509 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, reaffirmed its experimental/investigational classification for contact dissolution of gallstones under CPB 0509, effective November 27, 2025. If your team bills for gallstone treatment under the K80 code family, here's what this means for your claims.

Quick-Reference Table

Aetna Contact Dissolution Coverage Criteria and Medical Necessity Requirements 2025

The Aetna contact dissolution coverage policy under CPB 0509 in the CPB 0509 Aetna system is blunt: there are no covered indications for this procedure. Full stop.

Aetna classifies contact dissolution — also called direct solvent dissolution or litholysis — as experimental, investigational, and unproven for all gallstone presentations. The three agents used in this approach (ethyl propionate, isopropyl acetate, and methyl tertiary butyl ether) share a common problem: none has FDA approval for this indication. Aetna's position is that safety and effectiveness have not been established, so medical necessity cannot be met.

This matters for your billing team because gallstone presentations span a wide K80 code range. Patients with cholecystolithiasis, choledocholithiasis, and related variants all fall under ICD-10-CM codes K80.0 through K80.80 and beyond. If a provider proposes contact dissolution for any of these diagnoses, the claim will not survive Aetna adjudication.

Prior authorization for a procedure Aetna considers experimental is essentially a non-starter. Submitting a prior auth request for contact dissolution does not create a path to reimbursement under this coverage policy. Aetna's experimental designation overrides the prior authorization process — there is no criteria set that unlocks coverage here.

Aetna Contact Dissolution Exclusions and Non-Covered Indications

This is the entire substance of CPB 0509. There are no covered tiers or partial approvals. Aetna excludes contact dissolution across the board.

The three agents named in the policy — ethyl propionate, isopropyl acetate, and methyl tertiary butyl ether — are each individually called out. This is not a blanket catch-all exclusion that might have gaps. Aetna named every agent currently used in clinical practice for this approach and excluded them all.

The real issue here is that some providers and patients may view contact dissolution as a less invasive alternative to cholecystectomy. That clinical logic doesn't change Aetna's position. Without FDA approval and established clinical evidence, Aetna will not cover this — and the CPB 0509 Aetna policy update effective November 27, 2025 makes that explicit.

Watch for situations where a provider documents contact dissolution as part of a broader gallstone management plan. If that documentation lands on the claim or in the medical record, it creates claim denial exposure even when the primary billed service is something Aetna does cover.

Coverage Indications at a Glance

Aetna Contact Dissolution Billing Guidelines and Action Items 2025

The billing guidelines here are less about what to submit and more about what to stop submitting — and how to protect your revenue cycle from downstream exposure.

CPT, HCPCS, and ICD-10 Codes for Contact Dissolution Under CPB 0509

The CPB 0509 policy does not list specific CPT or HCPCS procedure codes for contact dissolution. This reflects the nature of the exclusion — there is no approved billing pathway for this procedure under Aetna. No CPT code maps to a covered service here.

The policy does enumerate 82 ICD-10-CM diagnosis codes across the K80 cholelithiasis family. These are the diagnosis codes your claims will carry for gallstone patients. Any of these codes paired with a contact dissolution procedure creates a claim denial under this coverage policy.

Key ICD-10-CM Diagnosis Codes for Gallstones Under CPB 0509

A note on the code descriptions: the policy data groups all 82 K80.x codes under the parent label "Cholelithiasis." In practice, these codes carry more specific clinical descriptions — choledocholithiasis with acute cholecystitis, with obstruction, with cholangitis, and so on. Your coding team should map the specific K80 subcategory to the documented diagnosis, not default to the parent code. Upcoding or under-coding within the K80 family is a separate risk — but the contact dissolution billing exclusion applies to every code in this family equally.