Aetna modified CPB 0690 covering noninvasive hepatic fibrosis testing, effective October 12, 2025. Here's what changes for billing teams.
Aetna, a CVS Health company, updated its hepatic fibrosis coverage policy under CPB 0690 to reflect the renamed MASH diagnosis (formerly NASH), clarify frequency limits across all covered test types, and expand the Enhanced Liver Fibrosis (ELF) test as a covered option for chronic liver disease. The primary affected codes are CPT 91200 (transient elastography/FibroScan), 76391 (MR elastography), 81596 (FibroTest/HCV-FibroSure), and 81517 (ELF test). If your practice bills for liver fibrosis workups on Aetna patients, this policy revision touches nearly every noninvasive test in your charge master.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Noninvasive Tests for Hepatic Fibrosis |
| Policy Code | CPB 0690 |
| Change Type | Modified |
| Effective Date | October 12, 2025 |
| Impact Level | High |
| Specialties Affected | Gastroenterology, Hepatology, Internal Medicine, Radiology |
| Key Action | Audit charge capture for CPT 91200, 76391, 81517, and 81596 against updated frequency and sequencing rules before October 12, 2025 |
Aetna Hepatic Fibrosis Coverage Criteria and Medical Necessity Requirements 2025
The real issue with CPB 0690 isn't which tests are covered — it's the frequency caps and the sequencing rules. Aetna won't cover any of these tests more than twice per year. That applies across the board: transient elastography (CPT 91200), MR elastography (CPT 76391), FibroTest/HCV-FibroSure (CPT 81596), and the ELF test (CPT 81517).
The sequencing rules are where claims get denied. Aetna will not cover any of these tests within six months of a liver biopsy (CPT 47000, 47001, or 47100). Transient elastography and FibroTest/HCV-FibroSure are also mutually exclusive within a six-month window — billing one blocks the other for six months. If your ordering providers aren't tracking biopsy dates and prior noninvasive test dates, you will generate denials.
Here's what each test covers under this Aetna hepatic fibrosis coverage policy:
Transient Elastography (CPT 91200 — FibroScan)
Aetna considers this medically necessary for three specific indications: follow-up of primary sclerosing cholangitis (K83.01), monitoring liver function in Wilson's disease (E83.01), and distinguishing cirrhosis from non-cirrhosis in hepatitis B (B18.0, B18.1), hepatitis C (B18.2), or other chronic liver diseases. That "other chronic liver diseases" bucket includes hereditary hemochromatosis (E83.110), NAFLD (K76.0), and MASH — the updated terminology for what was previously documented as NASH (K75.81).
FibroTest-ActiTest / HCV-FibroSure (CPT 81596)
Medical necessity here is narrower. Aetna covers it for distinguishing cirrhosis from non-cirrhosis in hepatitis C and other chronic liver diseases, including hereditary hemochromatosis, NAFLD, and MASH. It is not covered for monitoring primary biliary cholangitis (K83.09) — that's explicitly excluded.
Magnetic Resonance Elastography (CPT 76391)
Coverage applies specifically to NAFLD and MASH for fibrosis detection and prognosis. This is a tighter indication than you might expect. MRE is not covered for hepatitis C or chronic liver diseases outside the NAFLD/MASH category. Aetna classifies that broader use as experimental.
Enhanced Liver Fibrosis Test — ELF (CPT 81517)
This is the broadest covered test. Aetna considers it medically necessary for fibrosis detection and prognosis across chronic liver diseases generally — not limited to one disease category. The same frequency cap applies: no more than twice per year, and not within six months of a liver biopsy or other fibrosis test.
FIB-4 Index (AST, ALT, Platelets)
Aetna covers the component labs used to calculate FIB-4 for assessing NAFLD progression risk. These are standard chemistry panels, not bundled under a single fibrosis test code, but the medical necessity justification ties directly to NAFLD risk assessment.
One nuance worth flagging: the policy now consistently uses "MASH" (metabolic dysfunction-associated steatohepatitis) as the preferred term for what was previously coded and documented as NASH. Your documentation templates and diagnosis coding workflows should reflect ICD-10 code K75.81 alongside the updated clinical terminology. Payers increasingly match documentation language to policy language during review.
If you're unsure how the frequency and sequencing restrictions interact with your patient population's testing patterns, talk to your compliance officer before the October 12, 2025 effective date.
Aetna Hepatic Fibrosis Exclusions and Non-Covered Indications
Aetna's "experimental, investigational, or unproven" list is long here — and several items on it are things practices are actively billing today. Know these before you submit.
Acoustic Radiation Force Impulse Imaging (ARFI) — CPT 76981 appears in the covered codes table when selection criteria are met, but ARFI specifically for distinguishing cirrhosis in hepatitis C and other chronic liver diseases is classified as experimental. That's a contradiction worth flagging. If you're billing 76981 for ARFI indications, verify the specific clinical context against the criteria before submission.
Artificial Intelligence Tools — Any AI-based approach for distinguishing healthy versus NAFLD/MASH, staging fibrosis, or screening for fatty liver disease is not covered. This is a categorical exclusion, not indication-specific.
FibroTest for Primary Biliary Cholangitis — CPT 81596 is covered for hepatitis C and NAFLD/MASH. It is not covered for monitoring primary biliary cholangitis (K83.09). Document the diagnosis carefully — a wrong ICD-10 on this code is a straight denial.
Hepatic Artery Resistive Index — Not covered for NAFLD fibrosis progression evaluation.
Intestinal Barrier Biomarkers — Tests using occludin, intestinal-type fatty-acid-binding proteins, or lipopolysaccharides for MASLD are experimental.
MR Elastography Outside NAFLD/MASH — CPT 76391 is not covered for hepatitis C or other chronic liver diseases outside the NAFLD/MASH category. If your hepatologist orders MRE for a hepatitis C patient, that claim will be denied.
Quantitative MRI Tissue Composition Tests (CPT 0648T, 0649T, 0697T, 0698T) — All four are not covered for indications listed in CPB 0690.
NASHnext, OWLiver Panel, 0344U, 0468U — These proprietary panels are excluded. CPT 0344U (lipid marker evaluation for NAFLD) and 0468U (miR-34a-5p panel for NASH) are both listed as not covered.
The excluded serum marker tests — billed under CPT 0166U, 83520, 83883, or 88342 for products like FIBROspect, FibroMeter, or HCV-FibroSure variants beyond the standard FibroTest — are also not covered under this policy.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Transient elastography for primary sclerosing cholangitis follow-up | Covered | CPT 91200, K83.01 | Max 2x/year; not within 6 months of biopsy or FibroTest |
| Transient elastography for Wilson's disease liver monitoring | Covered | CPT 91200, E83.01 | Max 2x/year |
| Transient elastography for hepatitis B/C or other chronic liver disease (cirrhosis vs. non-cirrhosis) | Covered | CPT 91200, B18.0, B18.1, B18.2, K74.60–K74.69 | Max 2x/year |
| FibroTest/HCV-FibroSure for hepatitis C or chronic liver disease (cirrhosis vs. non-cirrhosis) | Covered | CPT 81596, B18.2, K76.0, K75.81 | Max 2x/year; not within 6 months of biopsy or transient elastography |
| MR elastography for NAFLD/MASH fibrosis detection and prognosis | Covered | CPT 76391, K76.0, K75.81 | Max 2x/year; not within 6 months of any liver fibrosis test |
| ELF test for chronic liver disease fibrosis detection and prognosis | Covered | CPT 81517, K74.0–K74.2 | Max 2x/year; not within 6 months of biopsy or other fibrosis test |
| FIB-4 index component labs for NAFLD risk assessment | Covered | Standard chemistry panels; K76.0 | No separate fibrosis test frequency cap applies |
| FibroTest/HCV-FibroSure for primary biliary cholangitis monitoring | Not Covered | CPT 81596, K83.09 | Explicitly excluded |
| MR elastography for hepatitis C or non-NAFLD/MASH chronic liver disease | Not Covered / Experimental | CPT 76391, B18.2 | Outside covered indication |
| ARFI for hepatitis C / chronic liver disease (cirrhosis distinction) | Experimental | CPT 76981 | Listed as experimental despite code appearing in covered table |
| AI-based NAFLD/MASH screening or fibrosis staging | Experimental | N/A | Categorical exclusion |
| Quantitative MRI tissue composition analysis | Not Covered | CPT 0648T, 0649T, 0697T, 0698T | All four codes excluded |
| NASHnext, OWLiver Panel, lipid marker panels | Not Covered | CPT 0344U, 0468U | Proprietary panels excluded |
| Intestinal barrier biomarkers for MASLD | Experimental | N/A | Occludin, IFABP, LPS-based tests excluded |
| Hepatic artery resistive index for NAFLD fibrosis | Experimental | N/A | Not covered for any fibrosis progression evaluation |
Aetna Hepatic Fibrosis Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 91200, 76391, 81517, and 81596 before October 12, 2025. Confirm each code maps to a covered indication. MRE (76391) billed for hepatitis C without a NAFLD/MASH diagnosis is a denial waiting to happen. |
| 2 | Build frequency edits into your billing system. Flag any claim for CPT 91200, 76391, 81517, or 81596 when the same code has already been billed twice in a rolling 12-month period for that patient. This is a straightforward edit that prevents billing errors before submission. |
| 3 | Add a 180-day look-back check for sequencing conflicts. Before billing transient elastography or FibroTest, your billing workflow should verify no liver biopsy (CPT 47000, 47001, 47100) was performed in the prior six months. The same check applies between transient elastography and FibroTest — they block each other within six months. |
| 4 | Update documentation templates to use "MASH" alongside K75.81. The policy now uses MASH as the primary term. Documentation that still says only "NASH" may create a mismatch during medical necessity review. Update your EHR templates to include both the updated terminology and the correct ICD-10 code. |
| 5 | Remove 0344U, 0468U, 0648T, 0649T, 0697T, and 0698T from any Aetna charge capture workflows for hepatic fibrosis. These codes are not covered under CPB 0690. If your lab or radiology team has been billing these for Aetna patients, stop now and review historical claims for potential overpayment exposure. |
| 6 | Verify prior authorization requirements with Aetna directly for CPT 76391 and 81517. The policy establishes medical necessity criteria but doesn't specify prior authorization requirements explicitly. For high-cost tests like MR elastography, check Aetna's prior auth requirements at the plan level before scheduling. A covered test without prior auth is still a denial. |
| 7 | Review reimbursement rates under your Aetna contracts for CPT 81517. The ELF test is a relatively new covered code. Confirm your fee schedule reflects current reimbursement rates, and verify the code is active in your chargemaster before the effective date. |
| 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 Hepatic Fibrosis Testing Under CPB 0690
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 76391 | CPT | Magnetic resonance elastography |
| 76981 | CPT | Ultrasound, elastography; parenchyma (e.g., organ) |
| 81517 | CPT | Liver disease, analysis of 3 biomarkers (hyaluronic acid, procollagen III amino terminal peptide…) — ELF test |
| 81596 | CPT | Infectious disease, chronic HCV infection, six biochemical assays (ALT, A2-macroglobulin…) — FibroTest/HCV-FibroSure |
| 91200 | CPT | Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation — FibroScan |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0002M | Proprietary Lab Assay | Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT…) | Not covered for indications listed in CPB 0690 |
| 0003M | Proprietary Lab Assay | Liver disease, ten biochemical assays (variant) | Not covered for indications listed in CPB 0690 |
| 0344U | Proprietary Lab Assay | Hepatology (NAFLD), semiquantitative evaluation of 28 lipid markers | Not covered for indications listed in CPB 0690 |
| 0468U | Proprietary Lab Assay | Hepatology (NASH/MASH), miR-34a-5p, alpha 2-macroglobulin, YKL40, HbA1c… | Not covered for indications listed in CPB 0690 |
| 0648T | CPT Category III | Quantitative MRI for tissue composition (fat, iron, water content), including liver | Not covered for indications listed in CPB 0690 |
| 0649T | CPT Category III | Quantitative MRI for tissue composition (fat, iron, water content), including liver — add-on | Not covered for indications listed in CPB 0690 |
| 0697T | CPT Category III | Quantitative MRI for tissue composition (fat, iron, water content), each additional organ | Not covered for indications listed in CPB 0690 |
| 0698T | CPT Category III | Quantitative MRI for tissue composition (fat, iron, water content), each additional organ — add-on | Not covered for indications listed in CPB 0690 |
| 0723T | CPT Category III | Quantitative MR cholangiopancreatography (QMRCP), including data preparation and transmission | Not covered for indications listed in CPB 0690 |
| 0724T | CPT Category III | Quantitative MR cholangiopancreatography (QMRCP), add-on | Not covered for indications listed in CPB 0690 |
| 76982 | CPT | Ultrasound, elastography — targeted lesion | Not covered for indications listed in CPB 0690 |
| 76983 | CPT | Ultrasound, elastography — add-on | Not covered for indications listed in CPB 0690 |
| 82728 | CPT | Ferritin | Not covered for indications listed in CPB 0690 |
| 0166U | Proprietary Lab Assay | Liver disease, 10 biochemical assays (α2-macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, GGT…) | Hepatic artery resistive index / serum markers group — not covered |
| 83520 | CPT | Immunoassay, analyte, quantitative; not otherwise specified (if billed for FIBROspect or HCV-FIBROSURE / FibroMeter) | Not covered |
| 83883 | CPT | Nephelometry, each analyte not elsewhere specified (if billed for FIBROspect or HCV-FIBROSURE / FibroMeter) | Not covered |
| 88342 | CPT | Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure (if billed for FIBROspect) | Not covered |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| B18.0 | Chronic viral hepatitis B with delta-agent |
| B18.1 | Chronic viral hepatitis B without delta-agent |
| B18.2 | Chronic viral hepatitis C |
| E83.01 | Wilson's disease |
| E83.110 | Hereditary hemochromatosis |
| E88.01 | Alpha-1-antitrypsin deficiency |
| E80.4 | Gilbert syndrome |
| K74.0 | Hepatic fibrosis, early fibrosis |
| K74.1 | Hepatic fibrosis, advanced fibrosis |
| K74.2 | Hepatic fibrosis with hepatic sclerosis |
| K74.60–K74.69 | Other and unspecified cirrhosis of liver |
| K75.81 | Nonalcoholic steatohepatitis (NASH/MASH) |
| K76.0 | Fatty (change of) liver, not elsewhere classified (NAFLD) |
| K76.6 | Portal hypertension |
| K83.01 | Primary sclerosing cholangitis |
| K83.09 | Other cholangitis (primary biliary cholangitis) |
| I85.0 | Esophageal varices with bleeding |
| I85.1 | Esophageal varices without bleeding |
| Q44.70–Q44.75 | Other congenital malformations of liver (Alagille syndrome) |
| E74.0–E74.9 | Glycogen storage disease / glycogenic hepatopathy |
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