TL;DR: Aetna, a CVS Health company, modified CPB 0613 covering 3D stereolithographic models and implants, effective December 5, 2025. Every application listed in this policy — including pre-operative planning models, 3D printed cranial implants, and surgical guides — is classified as experimental. CPT codes 0559T, 0560T, 0561T, and 0562T are explicitly not covered. Here's what billing teams need to do.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna |
| Policy | Stereolithographic Models and Implants |
| Policy Code | CPB 0613 |
| Change Type | Modified |
| Effective Date | December 5, 2025 |
| Impact Level | High |
| Specialties Affected | Cardiac surgery, plastic & reconstructive surgery, neurosurgery, radiation oncology, oral & maxillofacial surgery, craniofacial surgery |
| Key Action | Remove CPT 0559T–0562T from charge capture for all Aetna patients immediately and audit any claims submitted after December 5, 2025 |
Aetna 3D Stereolithographic Model Coverage Policy and Medical Necessity Requirements 2025
The Aetna 3D stereolithographic model coverage policy under CPB 0613 Aetna system is unambiguous: there is no covered indication. Aetna does not recognize 3D printing of anatomic structures as meeting medical necessity for any of the applications listed in this policy. That includes pre-operative planning, surgical guides, cardiac surgery, plastic and reconstructive surgery, brachytherapy, and 3D printed cranial implants.
This is the piece that trips up billing teams. Surgeons and surgical planning teams sometimes treat 3D printed models as routine pre-op tools. From a clinical workflow standpoint, they may be. From an Aetna reimbursement standpoint, they are not covered — period.
The policy does not include a pathway to coverage through prior authorization. There are no criteria to meet, no documentation thresholds to clear. Aetna simply does not consider these services proven effective enough to cover. If your physicians are billing CPT 0559T or 0561T on Aetna claims — or adding 0560T and 0562T as add-on codes — those claims will deny.
This also applies to 3D printing billing on commercial Aetna plans. Don't assume a patient's specific plan might be an exception without verifying coverage at the plan level. Contact Aetna directly for plan-specific benefit questions, especially for self-funded accounts where plan documents can differ from standard CPBs.
Aetna 3D Printing and Stereolithographic Model Exclusions and Non-Covered Indications
Aetna classifies four specific applications as experimental, investigational, or unproven under CPB 0613. Each one matters to a different specialty — and all of them lead to the same billing outcome.
3D stereolithographic models in cardiac surgery and plastic/reconstructive surgery. This affects pre-operative planning workflows in complex cardiac cases and reconstructive procedures. Surgeons may use printed models to rehearse procedures or fit implants before surgery. Aetna does not consider the clinical evidence sufficient to support coverage.
3D stereolithographic models in penile surface mold brachytherapy. Radiation oncology teams using printed surface molds for brachytherapy dose delivery will not get reimbursement from Aetna for this component of the service. This is a narrow indication but worth flagging for any oncology billing team.
3D printed cranial implants. Neurosurgery and craniofacial surgery teams need to pay close attention here. Custom cranial implants manufactured via 3D printing — regardless of how clinically appropriate they appear — are not covered under this coverage policy. If your team is submitting claims for these implants on Aetna patients, you have a claim denial problem that needs to be addressed before December 5, 2025.
3D printing of anatomic structures for pre-operative planning and other applications. This is the broadest category. "Other applications" is deliberately wide. Any use of 3D printed anatomic models tied to surgical planning falls here. The policy does not carve out exceptions for pediatric cases, complex trauma, or rare congenital anomalies.
The real issue here is that "experimental" under Aetna's CPB framework means the safety and effectiveness of these services has not been established to Aetna's standard. That's a formal designation — not a soft suggestion. It changes how you handle patient financial liability, ABN-equivalent notices, and appeals strategy.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| 3D stereolithographic models in cardiac surgery | Not Covered / Experimental | 0559T, 0560T | No coverage pathway; experimental designation |
| 3D stereolithographic models in plastic & reconstructive surgery | Not Covered / Experimental | 0559T, 0560T | No coverage pathway; experimental designation |
| 3D stereolithographic models in penile surface mold brachytherapy | Not Covered / Experimental | 0559T, 0560T | Radiation oncology; no coverage pathway |
| 3D printed cranial implants | Not Covered / Experimental | 0559T, 0560T | Neurosurgery / craniofacial; no coverage pathway |
| 3D printing of anatomic structures for pre-operative planning | Not Covered / Experimental | 0559T, 0560T, 0561T, 0562T | Broadest category; all applications included |
| 3D printed anatomic guides | Not Covered / Experimental | 0561T, 0562T | Surgical guides; same experimental designation |
Aetna 3D Printing Billing Guidelines and Action Items 2025
These steps are specific to this policy change. Work through them before December 5, 2025.
| # | Action Item |
|---|---|
| 1 | Remove CPT 0559T, 0560T, 0561T, and 0562T from your Aetna charge capture. These are the primary 3D printing codes for anatomic models and surgical guides. If they're live in your charge master or superbill for Aetna payer contracts, flag them as non-covered. Do this now — not after you get your first denial. |
| 2 | Audit claims submitted after December 5, 2025 for these codes. If any claims went out with 0559T–0562T on an Aetna payer ID after the effective date, pull them. Assess whether you can retract and resubmit without the non-covered codes, or whether you need to write off the charges. Early action is cleaner than a post-denial correction cycle. |
| 3 | Review your pre-op planning workflows for specialty-specific exposure. Cardiac surgery, plastic/reconstructive surgery, neurosurgery, and craniofacial surgery teams are your highest-risk service lines. Talk to your surgical coordinators and OR scheduling teams. If 3D printed models are part of their standard pre-op protocol, they need to know these are not billable to Aetna. |
| 4 | Notify patients before the service, not after. When 3D printing is part of a planned procedure and Aetna is the payer, give the patient a written financial responsibility notice before the service. You cannot collect from a patient without proper advance notice. This step protects your practice and keeps the patient relationship intact. |
| 5 | Don't assume the related CPT codes (21076–21088 and the facial reconstruction series) are affected the same way. The policy groups the 2100-range CPT codes under "other CPT codes related to the CPB." That designation means they're contextually related — not automatically non-covered. Impressions, custom preparations, and maxillofacial reconstruction codes have their own coverage criteria. Don't let the broad scope of this policy create false claim denials on separately covered services. |
| 6 | If you bill for 3D printed cranial implants specifically, loop in your compliance officer. The implant component adds a layer of complexity — there may be separate charges for the implant itself, surgical placement, and facility components. Your compliance officer and billing consultant should review how the experimental designation interacts with your full claim structure before the effective date of December 5, 2025. |
| 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 Stereolithographic Models and Implants Under CPB 0613
Not Covered / Experimental Codes
These four codes are explicitly not covered for the indications listed in CPB 0613. Billing them to Aetna will result in claim denial.
| Code | Type | Description | Reason |
|---|---|---|---|
| 0559T | CPT | Anatomic model 3D-printed from image data set(s); first individually prepared and processed component | Experimental / not covered per CPB 0613 |
| 0560T | CPT | Anatomic model 3D-printed from image data set(s); each additional individually prepared and processed component (add-on) | Experimental / not covered per CPB 0613 |
| 0561T | CPT | Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide | Experimental / not covered per CPB 0613 |
| 0562T | CPT | Anatomic guide 3D-printed and designed from image data set(s); each additional anatomic guide (add-on) | Experimental / not covered per CPB 0613 |
ICD-10-CM Diagnosis Codes
The policy data does not list specific ICD-10-CM diagnosis codes for this CPB. Aetna does not designate covered diagnoses for these procedures because the procedures themselves are not covered under any indication.
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