TL;DR: Aetna, a CVS Health company, modified CPB 0613 covering stereolithographic models and implants, effective December 5, 2025. Every major use of 3D printing in surgical planning and implant fabrication is non-covered — and CPT codes 0559T, 0560T, 0561T, and 0562T are the denial magnets your billing team needs to flag now.
Aetna's 3D printing coverage policy under CPB 0613 in the Aetna system draws a hard line: cardiac surgery models, reconstructive surgery models, cranial implants, penile surface mold brachytherapy, and general pre-operative anatomic models are all experimental, investigational, or unproven. The policy touches 203 CPT codes — spanning anatomic model codes (0559T–0562T) through the full range of craniofacial and maxillofacial reconstruction codes (21076–21088, 21100–21180, and beyond). If your practice bills for 3D-printed surgical planning tools under any Aetna plan, your exposure is significant.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Stereolithographic Models and Implants — CPB 0613 |
| Policy Code | CPB 0613 |
| Change Type | Modified |
| Effective Date | December 5, 2025 |
| Impact Level | High |
| Specialties Affected | Cardiac surgery, plastic and reconstructive surgery, craniofacial surgery, maxillofacial surgery, radiation oncology (brachytherapy), neurosurgery |
| Key Action | Audit all claims with CPT 0559T, 0560T, 0561T, and 0562T for Aetna patients and halt billing pending coverage confirmation |
Aetna 3D Printing Coverage Criteria and Medical Necessity Requirements 2025
The Aetna 3D printing coverage policy under CPB 0613 does not establish any pathway to coverage for stereolithographic models or implants. There are no medical necessity criteria to meet. There is no prior authorization route that unlocks reimbursement.
That's the real point here. Usually when a payer modifies a policy like this, you're looking for the carve-outs — the specific diagnoses or settings where coverage survives. CPB 0613 offers none for 3D printing applications. Aetna's position is categorical: these technologies have not demonstrated sufficient evidence of improved outcomes to warrant coverage.
This matters for billing teams because "experimental or investigational" denials behave differently than standard medical necessity denials. You can't fix them with better documentation or a stronger letter of medical necessity. The coverage policy itself is the wall.
If your providers bill CPT 0559T (anatomic model, 3D-printed from image data, first component) or the add-on code 0560T (each additional component), those claims will deny under Aetna. The same applies to 0561T (anatomic guide, 3D-printed, first guide) and 0562T (each additional guide). These four codes are the primary 3D printing billing codes established by AMA, and all four sit in the "not covered" bucket for every indication listed in CPB 0613.
Whether this change affects your 3D printing billing volume depends on your Aetna payer mix. If you're a craniofacial center, a cardiac surgery program, or a radiation oncology group doing brachytherapy — pay attention before December 5, 2025.
Aetna Stereolithographic Models and Implants Exclusions and Non-Covered Indications
Aetna classifies four distinct use cases as experimental, investigational, or unproven under CPB 0613. None of them have a covered alternative path within this policy.
3D stereolithographic models in cardiac surgery. Cardiac surgery teams use 3D models for pre-operative planning on complex congenital or structural heart cases. Aetna does not cover the models themselves for these procedures.
3D stereolithographic models in plastic and reconstructive surgery. This includes models used for reconstruction following trauma, oncologic resection, or congenital deformity. Craniofacial teams that routinely print models for surgical rehearsal will see claim denial on the model-related charges.
3D stereolithographic models in penile surface mold brachytherapy. This is a more targeted exclusion. Radiation oncology groups using 3D-printed molds to customize brachytherapy delivery should not bill for those models under Aetna.
3D printing of anatomic structures for pre-operative planning and other applications. This is the catch-all. It explicitly extends non-coverage beyond the three named specialties above. If your team uses 3D-printed anatomic structures for any pre-surgical planning purpose, Aetna does not consider it covered.
The "other applications" language is intentionally broad. Aetna is not limiting this exclusion to a discrete list of procedures. Your compliance officer should review any 3D printing workflow your practice has — not just the three named specialties — before December 5, 2025.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| 3D stereolithographic models — cardiac surgery | Not Covered (Experimental) | 0559T, 0560T | No prior authorization pathway available |
| 3D stereolithographic models — plastic and reconstructive surgery | Not Covered (Experimental) | 0559T, 0560T | Includes post-oncologic and trauma reconstruction |
| 3D stereolithographic models — penile surface mold brachytherapy | Not Covered (Experimental) | 0559T, 0560T | Applies to radiation oncology model fabrication |
| 3D printed cranial implants | Not Covered (Experimental) | 0559T, 0560T | Distinct from standard cranioplasty implants billed under maxillofacial codes |
| 3D printing of anatomic structures for pre-operative planning | Not Covered (Experimental) | 0559T, 0560T, 0561T, 0562T | Broad catch-all — covers any specialty using anatomic models in surgical planning |
| 3D-printed anatomic guides (surgical cutting or positioning guides) | Not Covered (Experimental) | 0561T, 0562T | Includes patient-specific instrument guides |
| Craniofacial / maxillofacial reconstruction procedures (non-3D-printed) | Related — Coverage depends on individual procedure | 21076–21088, 21100–21180 range | These codes are related to the CPB; coverage determined by individual procedure criteria, not CPB 0613 |
| Maxillofacial impression and custom preparation | Related — Coverage depends on individual procedure | 21076–21088 | Not directly excluded by CPB 0613; standard coverage rules apply |
Aetna 3D Printing Billing Guidelines and Action Items 2025
Here's what your billing and revenue cycle teams need to do before December 5, 2025.
| # | Action Item |
|---|---|
| 1 | Pull a claims history report for CPT 0559T, 0560T, 0561T, and 0562T billed to Aetna in the last 12 months. Look at volumes, reimbursement rates, and denial rates. If you've been getting paid on some of these, understand why — it may reflect a plan-level carve-out that's now at risk, or it may reflect a processing gap that Aetna could recoup. |
| 2 | Update your charge capture and charge description master (CDM) to flag 0559T, 0560T, 0561T, and 0562T for Aetna patients. These should route to a billing hold or compliance review before claim submission, effective December 5, 2025. |
| 3 | Notify your surgical and radiation oncology teams that 3D-printed model charges are non-billable to Aetna. Surgeons often don't know what gets billed downstream from their pre-op workflow. A short communication from your revenue cycle director is enough — this doesn't need to be a clinical policy change, just an awareness note. |
| 4 | Review your ABN and patient financial responsibility workflows. Because Aetna classifies these as experimental, you may have the ability to obtain an advance notice from the patient before performing 3D printing services. Whether that's viable depends on your state and your practice structure — talk to your compliance officer before assuming it is. |
| 5 | Do not assume the related maxillofacial codes (21076–21088 and the 21100–21180 range) are affected in the same way. CPB 0613 lists these as "other CPT codes related to the CPB" — not as non-covered. The exclusion in this policy is specifically for the 3D-printed component of care, not for the underlying reconstructive procedures themselves. Conflating the two will create unnecessary claim disruption. |
| 6 | If your practice has Aetna commercial plans, check the individual plan documents. CPB 0613 governs Aetna's standard commercial products, but self-funded ERISA plans can vary. Some self-funded employers may have added 3D printing coverage as a benefit enhancement. The coverage policy is Aetna's default — it's not universal across every plan they administer. |
| 7 | If you have significant revenue tied to 3D printing services for Aetna patients, talk to your billing consultant or compliance officer now. The effective date of December 5, 2025 is the hard line. Claims for services on or after that date under the current policy language carry meaningful denial risk. |
| 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 CPT Codes
These four codes are explicitly non-covered for all indications listed in CPB 0613. Billing these to Aetna for any of the named or related applications will result in claim denial.
| Code | Type | Description | Coverage Status |
|---|---|---|---|
| 0559T | CPT | Anatomic model 3D-printed from image data set(s); first individually prepared and processed component | Not Covered — Experimental |
| 0560T | CPT | Each additional individually prepared and processed component of an anatomic structure (add-on) | Not Covered — Experimental |
| 0561T | CPT | Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide | Not Covered — Experimental |
| 0562T | CPT | Each additional anatomic guide (add-on) | Not Covered — Experimental |
ICD-10-CM Diagnosis Codes
CPB 0613 does not list specific ICD-10-CM diagnosis codes. Aetna's non-coverage determination for 3D printing applies across diagnoses — the exclusion is technology-based, not diagnosis-based.
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