Exhaled Breath Tests — CPB 0691 | AETNA Coverage Update

Aetna modified CPB 0691 for exhaled breath tests, effective October 18, 2025. Here's what changes for billing teams.

Aetna, a CVS Health company, updated its exhaled breath test coverage policy under CPB 0691 Aetna system. Two CPT codes drive most of the financial exposure here: CPT 91065 (hydrogen breath test) and CPT 95012 (exhaled nitric oxide). The update draws sharp lines around covered indications — and the exclusion list is long. If your practice bills for any breath-based diagnostic, audit your charge capture before October 18, 2025.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna
Policy	Exhaled Breath Tests — CPB 0691
Policy Code	CPB 0691
Change Type	Modified
Effective Date	October 18, 2025
Impact Level	Medium
Specialties Affected	Pulmonology, Gastroenterology, Allergy/Immunology, Primary Care
Key Action	Audit all exhaled breath test claims against updated medical necessity criteria for CPT 91065 and 95012 before October 18, 2025

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Aetna Exhaled Breath Test Coverage Criteria and Medical Necessity Requirements 2025

The Aetna exhaled breath test coverage policy under CPB 0691 covers exactly two tests — and both come with specific criteria you must meet before billing.

CPT 91065 — Hydrogen Breath Test (HBT)

Aetna covers HBT for suspected lactose intolerance or lactase deficiency. The coverage hinges on a specific clinical sequence. The member must first complete a two-week trial of a lactose-free diet. Symptoms must persist after that trial. Only then does CPT 91065 meet medical necessity under this policy.

Skip the documentation of the dietary trial, and you're looking at a claim denial. There's no wiggle room in the language here.

CPT 95012 — Exhaled Nitric Oxide (FeNO)

Aetna covers exhaled nitric oxide measurement for two purposes: evaluation of asthma and monitoring response to long-term control therapy. The age requirement matters — coverage applies to members aged five years and older. Billing CPT 95012 for a child under five will not meet medical necessity under this policy.

Prior authorization requirements are not explicitly detailed in CPB 0691 itself, but Aetna's prior auth rules vary by plan. Check eligibility and benefits before scheduling FeNO testing, especially for commercial versus Medicaid versus Medicare Advantage lines. If you're unsure how prior auth applies to your patient mix under CPB 0691, loop in your billing consultant before the effective date.

The coverage policy is narrow by design. Aetna has not expanded HBT coverage to SIBO, IBS, or bowel prep evaluation — common clinical uses that providers sometimes bill and expect reimbursement on. Those remain non-covered.

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Aetna Exhaled Breath Test Exclusions and Non-Covered Indications

This is where CPB 0691 gets expensive if your team isn't careful. The experimental and non-covered list covers thirteen categories — and several reflect tests that some labs are actively marketing to providers right now.

Hydrogen Breath Testing — Non-Covered Uses

Aetna will not cover CPT 91065 for irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), small bowel transit time, gastroparesis, or prediction of bowel preparation adequacy before colonoscopy. SIBO testing via HBT is one of the most common sources of claim denial under breath test policies. If your gastroenterology group has been billing HBT for SIBO, stop and audit those claims now.

Exhaled Nitric Oxide — Non-Covered Uses

CPT 95012 is non-covered for chronic cough due to non-asthmatic eosinophilic bronchitis, pulmonary hypertension biomarker use, lung cancer evaluation, COPD, chronic tonsillitis, sickle cell airway disease, and prediction of response to inhaled corticosteroids in chronic cough. The list goes further — acute mountain sickness and airway inflammation from bioaerosol exposures are also excluded.

Tests Aetna Considers Experimental or Investigational

CPT 83987, which measures exhaled breath condensate (EBC) pH, is not covered for any indication under this policy. That includes asthma, lung cancer, obstructive sleep apnea, inflammatory bowel diseases, COPD, SARS-CoV-2, and sino-nasal disease.

Beyond those coded tests, Aetna classifies the following as experimental or unproven:

The real issue here is the GEBT. Gastric emptying breath tests have been gaining clinical traction, and some providers assumed coverage would follow. It hasn't. Aetna explicitly calls GEBT experimental for gastroparesis and all other indications.

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Coverage Indications at a Glance

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Aetna Exhaled Breath Test Billing Guidelines and Action Items 2025

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Exhaled Breath Tests Under CPB 0691

Covered CPT Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
91065	CPT	Breath hydrogen or methane test (e.g., for detection of lactase deficiency, fructose intolerance, bacterial overgrowth)
95012	CPT	Nitric oxide expired gas determination

Not Covered CPT Codes

Code	Type	Description	Reason Copy
83987	CPT	pH; exhaled breath condensate	Not covered for any listed indication under CPB 0691

Key ICD-10-CM Diagnosis Codes

The policy references 424 ICD-10-CM codes in total. The table below includes the primary diagnostic categories explicitly named in CPB 0691.

The full ICD-10-CM code set (424 codes total) is available in the complete CPB 0691 policy document. Access the full policy at PayerPolicy.org.

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