Headaches: Invasive Procedures — CPB 0707 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0707 covering invasive procedures for headaches, effective February 14, 2026. The policy classifies a sweeping list of surgical and interventional treatments as experimental or unproven — and if your team bills any of the 151+ CPT codes listed, you need to review your charge capture now.

This Aetna headache invasive procedures coverage policy is one of the broadest experimental-designation policies in the neurology and pain management space. CPB 0707 covers everything from occipital nerve blocks and sphenopalatine ganglion injections to bariatric surgery for migraines and deep brain stimulation. Codes like CPT 64405 (greater occipital nerve), 64505 (sphenopalatine ganglion injection), 61796–61800 (stereotactic radiosurgery), and the full range of neurostimulator implant codes fall under this policy. If your practice sees headache patients and performs interventional procedures, this update has direct financial exposure.

Quick-Reference Table

Aetna Headache Invasive Procedure Coverage Criteria and Medical Necessity Requirements 2026

The core position in CPB 0707 is blunt: Aetna considers the vast majority of invasive procedures for headaches — across cervicogenic, occipital, cluster, migraine, and other chronic headache types — experimental, investigational, or unproven. Medical necessity is not established, in Aetna's view, for most of these interventions.

There is one meaningful carve-out. Botulinum toxin for chronic migraine is not automatically excluded under this policy. Aetna considers it medically necessary when the criteria in CPB 0113 (Botulinum Toxin) are met. If your practice bills botulinum toxin for chronic migraine, your path to reimbursement runs through CPB 0113 — not CPB 0707.

Occipital nerve block (CPT 64405) gets a narrow allowance. Aetna will cover it for diagnosing occipital neuralgia only. Use it for prophylaxis or treatment of migraine, and it shifts to experimental. That's a distinction your charge capture logic needs to reflect, because the same CPT code pulls different coverage outcomes depending on the documented indication.

Prior authorization alone will not rescue a claim for a procedure Aetna classifies as experimental. The experimental designation is a hard stop — no amount of prior auth paperwork converts a non-covered intervention to a covered one. If you're billing for these procedures and expecting prior authorization to protect your reimbursement, that assumption is wrong under this coverage policy.

Aetna Headache Invasive Procedure Exclusions and Non-Covered Indications

This is where CPB 0707 does most of its work. The experimental list is long, and it spans three distinct headache categories. Knowing which bucket applies matters for documentation and for any appeal you might file.

Cervicogenic headache exclusions include botulinum toxin (absent CPB 0113 criteria), C2 ganglion nerve block, cryo-denervation, decompressive neck surgery, electrical stimulation, ganglionectomy, local anesthetic or corticosteroid injections, and radiofrequency denervation of cervical facet joints.

Occipital neuralgia and other headache type exclusions cover a wider range. Auriculotemporal nerve block, cervical rhizotomy, cryo-denervation, occipital nerve decompression, dorsal column stimulation, electrical stimulation of the occipital nerve (including ONSTIM and PRISM devices), ganglionectomy, intradural rhizotomy, ligation of supraorbital and supratrochlear arteries, neurectomy, neurolysis of the great occipital nerve, neuroplasty, pulsed radiofrequency ablation, radiofrequency ablation of the occipital nerve, tissue resection from the forehead or scalp, semispinalis capitus muscle resection, supraorbital nerve block, suprascapular nerve block, surgical release of the lesser occipital nerve, transection or avulsion of the occipital nerve, and thermal neurolysis.

Cluster headache, chronic headache, and migraine exclusions are the broadest category. Sphenopalatine ganglion ablation or block (CPT 64505), bariatric surgery for migraines (the entire CPT 43644–43848 range), patent foramen ovale closure, decompression-avulsion neurectomy, deep brain stimulation (CPT 61863–61886), gamma knife radiosurgery (CPT 61796–61800), greater occipital nerve block for prophylaxis or migraine treatment, migraine trigger site surgery, nerve decompression, occipital nerve stimulation (CPT 64553, 64555), and peripheral nerve trigger surgery are all non-covered.

The real issue here is scope. Aetna is not drawing a narrow line. This policy excludes nearly every interventional option a headache specialist or pain management physician might reach for. That creates claim denial risk across a wide swath of procedure codes — not just a few outliers.

Coverage Indications at a Glance

Aetna Headache Invasive Procedure Billing Guidelines and Action Items 2026

CPT, HCPCS, and ICD-10 Codes for Headache Invasive Procedures Under CPB 0707

All codes below are classified as experimental, investigational, or unproven under CPB 0707 for the headache indications listed. Exceptions are noted.

Not Covered / Experimental CPT Codes

Note: The full policy lists 151 CPT codes. The policy source at app.payerpolicy.org/p/aetna/0707 contains the complete code set. The codes above represent all codes provided in the policy data for this summary. Review the full policy before February 14, 2026 to confirm your complete code exposure.