Aetna modified CPB 0731, classifying both convection-enhanced intraparenchymal drug delivery and MR-guided focused ultrasound (MRgFUS) blood-brain barrier disruption as experimental and non-covered, effective November 27, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated this coverage policy to explicitly address two techniques for delivering drugs to the brain: convection-enhanced delivery (CED) into brain parenchyma and low-intensity MRgFUS-mediated disruption of the blood-brain barrier. The policy ties directly to CPT code 0947T — the Category III code for MR-guided low-intensity focused ultrasound stereotactic blood-brain barrier disruption. If your practice or facility bills 0947T for any of the 25 ICD-10 diagnoses listed in CPB 0731 Aetna's system, expect denial. The effective date is November 27, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Selected Techniques for Delivery of Drugs to the Brain |
| Policy Code | CPB 0731 |
| Change Type | Modified |
| Effective Date | November 27, 2025 |
| Impact Level | Medium — targeted specialty impact for neurosurgery, neuro-oncology, and neurology billing teams |
| Specialties Affected | Neurosurgery, neuro-oncology, neurology, radiology (interventional MRI) |
| Key Action | Flag CPT 0947T as non-covered in your charge capture system and update denial workflows for the 25 listed ICD-10 codes before billing on or after November 27, 2025 |
Aetna Drug Delivery to the Brain Coverage Policy and Medical Necessity Requirements 2025
The Aetna convection-enhanced delivery and MRgFUS coverage policy under CPB 0731 is clear: neither technique meets Aetna's medical necessity standard. Aetna's position is that safety and effectiveness have not been established for either approach.
That's not a soft "coverage is limited" stance. That's a hard experimental designation. There is no clinical scenario described in this policy where convection-enhanced intraparenchymal delivery or MRgFUS blood-brain barrier disruption would qualify for reimbursement under an Aetna commercial plan.
For billing teams, "experimental, investigational, or unproven" means denial is automatic. Because Aetna classifies these procedures as experimental, prior authorization approval is unlikely — but confirm directly with Aetna for your specific plan before drawing conclusions about any individual case. Submitting CPT 0947T with any of the diagnosis codes listed in this policy won't change the coverage outcome — the code sits in the "not covered" group regardless of diagnosis.
The medical necessity question is already answered. The answer is no.
Aetna Convection-Enhanced Delivery and MRgFUS Exclusions and Non-Covered Indications
Both techniques covered under CPB 0731 carry the same designation. Aetna considers them experimental and unproven. Here's what that covers specifically.
Convection-enhanced intraparenchymal drug delivery uses positive pressure to infuse drugs directly into brain tissue. It's been studied for glioblastoma and other brain tumors — particularly for getting around the blood-brain barrier. Aetna's position is that the evidence base hasn't cleared the bar for covered status.
Low-intensity MRgFUS-mediated blood-brain barrier disruption uses focused ultrasound guided by MRI to temporarily open the blood-brain barrier. This allows systemic drugs to reach the brain at higher concentrations. CPT 0947T is the code created specifically for this procedure. Aetna's coverage policy puts this in the same experimental bucket.
The ICD-10 diagnosis list in this policy includes malignant brain tumors (C71.0–C71.9), secondary brain malignancies (C79.31, C79.49), Alzheimer's disease (G30.0–G30.9), epilepsy and recurrent seizures (G40.001–G40.909), post-traumatic seizures (R56.1), and unspecified convulsions (R56.9). These are exactly the conditions researchers have targeted with these techniques. None of them unlock coverage.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Malignant neoplasm of brain (primary) | Not Covered / Experimental | C71.0–C71.9, CPT 0947T | Applies to CED and MRgFUS; confirm prior auth approach directly with Aetna |
| Secondary malignant neoplasm of brain | Not Covered / Experimental | C79.31, C79.49, CPT 0947T | Brain metastases included in exclusion |
| Alzheimer's disease | Not Covered / Experimental | G30.0–G30.9, CPT 0947T | MRgFUS for drug delivery in Alzheimer's is experimental |
| Epilepsy and recurrent seizures | Not Covered / Experimental | G40.001–G40.909, CPT 0947T | All epilepsy codes in listed range excluded |
| Post-traumatic seizures | Not Covered / Experimental | R56.1, CPT 0947T | Excluded regardless of clinical context |
| Unspecified convulsions | Not Covered / Experimental | R56.9, CPT 0947T | Catch-all seizure code also excluded |
No covered indications exist in this policy. Every row in this table is a denial scenario.
Aetna Drug Delivery to the Brain Billing Guidelines and Action Items 2025
The policy modification is live as of November 27, 2025. If your team hasn't acted yet, act now. These are the steps to take.
| # | Action Item |
|---|---|
| 1 | Flag CPT 0947T as non-covered in your charge capture system. Add a hard stop or alert tied to this code for Aetna payers. Anyone billing 0947T against an Aetna commercial plan should get an immediate flag before claim submission. |
| 2 | Map the 25 ICD-10 codes to your denial management workflow. Pull C71.0–C71.9, C79.31, C79.49, G30.0–G30.9, G40.001–G40.909, R56.1, and R56.9 and confirm they're paired with 0947T in your denial tracking rules. A claim denial using these codes with this CPT should route to your appeals team, not to a resubmission queue. |
| 3 | Update any advanced beneficiary notice (ABN) equivalents or patient financial counseling scripts for Aetna patients. If your practice offers MRgFUS-guided drug delivery, patients with Aetna coverage need to know upfront that reimbursement is not available. Document that conversation. |
| 4 | Pull any pending prior auth requests that involve 0947T for Aetna. If your team submitted prior authorizations for this procedure under Aetna plans before the effective date of November 27, 2025, contact the payer directly to confirm status under the current policy. Redirect the patient conversation accordingly. |
| 5 | Audit claims billed on or after November 27, 2025 that include CPT 0947T with Aetna payer IDs. If any slipped through before you updated your charge capture, identify them now. Address denials proactively rather than waiting for Aetna to claw back payments. |
| 6 | Talk to your compliance officer if you're operating under an active clinical trial or research agreement. Some research billing situations have different rules. If your facility is billing for MRgFUS under a study protocol, your compliance officer needs to confirm how CPB 0731 interacts with your specific research billing arrangement before the next claim goes out. |
| 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 Drug Delivery to the Brain Under CPB 0731
Not Covered / Experimental CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0947T | CPT | Magnetic resonance image guided low intensity focused ultrasound (MRgFUS), stereotactic blood-brain barrier disruption (description abbreviated in source policy) | Not covered for any indication listed in CPB 0731 — experimental and investigational per Aetna policy |
Key ICD-10-CM Diagnosis Codes
These are the diagnosis codes Aetna lists in CPB 0731. All are associated with non-covered status when paired with 0947T.
| Code | Description |
|---|---|
| C71.0 | Malignant neoplasm of brain |
| C71.1 | Malignant neoplasm of brain |
| C71.2 | Malignant neoplasm of brain |
| C71.3 | Malignant neoplasm of brain |
| C71.4 | Malignant neoplasm of brain |
| C71.5 | Malignant neoplasm of brain |
| C71.6 | Malignant neoplasm of brain |
| C71.7 | Malignant neoplasm of brain |
| C71.8 | Malignant neoplasm of brain |
| C71.9 | Malignant neoplasm of brain |
| C79.31 | Secondary malignant neoplasm of brain and other parts of nervous system |
| C79.49 | Secondary malignant neoplasm of brain and other parts of nervous system |
| G30.0 | Alzheimer's disease |
| G30.1 | Alzheimer's disease |
| G30.2 | Alzheimer's disease |
| G30.3 | Alzheimer's disease |
| G30.4 | Alzheimer's disease |
| G30.5 | Alzheimer's disease |
| G30.6 | Alzheimer's disease |
| G30.7 | Alzheimer's disease |
| G30.8 | Alzheimer's disease |
| G30.9 | Alzheimer's disease |
| G40.001–G40.909 | Epilepsy and recurrent seizures (full range) |
| R56.1 | Post traumatic seizures |
| R56.9 | Unspecified convulsions |
The epilepsy range G40.001–G40.909 is broad. It covers a wide span of epilepsy and recurrent seizure codes. If your neurology team treats epilepsy patients and has explored MRgFUS-based drug delivery options, this entire code range is blocked under the CPB 0731 Aetna policy.
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