TL;DR: Aetna, a CVS Health company, modified CPB 0733 governing discography coverage, effective September 26, 2025. Billing teams using CPT 62290 and 72295 need to confirm patients meet all three medical necessity criteria before submitting claims.
Aetna's discography coverage policy under CPB 0733 Aetna system draws a hard line: lumbar provocative discography gets covered under a narrow set of conditions, and everything outside those conditions is experimental. The two lumbar codes — CPT 62290 (injection procedure) and CPT 72295 (radiological supervision and interpretation) — are covered when criteria are met. CPT 62291 and 72285, the cervical and thoracic equivalents, are not covered at all under this policy. If your practice bills discography for Aetna patients, this update sets the rules your claims will be measured against starting September 26, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Discography — CPB 0733 |
| Policy Code | CPB 0733 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Pain management, spine surgery, interventional radiology, neurosurgery, orthopedic surgery |
| Key Action | Audit all pending and future discography claims for CPT 62290 and 72295 against Aetna's three-part medical necessity criteria before submitting |
Aetna Discography Coverage Criteria and Medical Necessity Requirements 2025
Aetna's discography coverage policy covers lumbar provocative discography only when a patient meets all three of the following conditions simultaneously.
First: The patient has persistent, severe low back pain. Not moderate pain. Not intermittent pain. Persistent and severe.
Second: Imaging shows abnormal interspaces on MRI. This is a hard documentation requirement. If the MRI is normal, discography is not covered — full stop. The American Association of Neurological Surgeons and the Congress of Neurological Surgeons both back this position, and Aetna references their 2005 guidelines directly in the policy.
Third: Other diagnostic tests have failed to clearly identify the disc as the pain source, and the clinical team is actively considering surgical intervention. This isn't a pre-surgical checkbox. Aetna expects prior diagnostic workup to be exhausted first.
All three criteria must be present. One or two isn't enough for a covered claim.
For discography billing, CPT 62290 covers the injection procedure at each lumbar level. CPT 72295 covers the radiological supervision and interpretation. Both codes fall under "covered if selection criteria are met" — which means prior authorization requirements and documentation standards will apply at the plan level. Check the specific Aetna plan before assuming authorization isn't needed. Many Aetna commercial plans require prior auth for any invasive diagnostic procedure at this level.
The covered ICD-10 diagnosis codes under this policy span a wide range of lumbar pathology — from M54.50–M54.59 (low back pain) to M51.26–M51.27 (intervertebral disc displacement) to M48.061–M48.07 (spinal stenosis). The full list of 57 ICD-10 codes is in the code tables below. Your documentation needs to support one of those specific codes, and the clinical notes need to show the MRI findings and prior diagnostic failure. Generic "low back pain" on its own won't survive a medical necessity review.
Aetna Discography Exclusions and Non-Covered Indications
This is where most claim denials will come from. Aetna classifies lumbar provocative discography as experimental, investigational, or unproven for any indication outside the three-part criteria above.
That explicitly includes lumbosacral radiculopathy and chronic non-specific back pain. If a patient has either of those diagnoses and doesn't also meet the surgical consideration and failed workup criteria, the claim will deny.
The policy also calls out that discography should never be used as a stand-alone test to drive treatment decisions. If your physician's documentation frames discography as the primary decision-making tool rather than one piece of a larger diagnostic picture, expect scrutiny on appeal.
Cervical and thoracic discography gets a harder ruling. CPT 62291 (injection procedure for cervical or thoracic discography) and CPT 72285 (cervical or thoracic radiological supervision and interpretation) are not covered for any indication listed in this policy. There's no criteria pathway to covered status for those codes under CPB 0733. If your team has been billing 62291 or 72285 for Aetna patients, those claims aren't getting paid under this policy, and they weren't before this update either.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Lumbar disc pathology: persistent severe LBP + abnormal MRI + failed prior diagnostics + surgical consideration | Covered | CPT 62290, 72295 | All three criteria must be met simultaneously; prior auth likely required at plan level |
| Lumbosacral radiculopathy (criteria above not met) | Experimental / Not Covered | CPT 62290, 72295 | Explicitly listed as non-covered indication in CPB 0733 |
| Chronic non-specific back pain (criteria above not met) | Experimental / Not Covered | CPT 62290, 72295 | Explicitly listed as non-covered indication |
| Normal lumbar MRI — any indication | Not Covered | CPT 62290, 72295 | AANS/CNS guidelines cited; Aetna will not cover discography when MRI is normal |
| Discography as stand-alone diagnostic test | Not Covered | CPT 62290, 72295 | Policy explicitly states this use is not recommended for treatment decisions |
| Cervical discography — any indication | Not Covered | CPT 62291, 72285 | No covered pathway exists under CPB 0733 |
| Thoracic discography — any indication | Not Covered | CPT 62291, 72285 | No covered pathway exists under CPB 0733 |
Aetna Discography Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 62290 and 72295 before September 26, 2025. Pull every Aetna discography claim from the past 90 days and confirm each one has documentation supporting all three medical necessity criteria. If any claim lacks MRI findings, prior diagnostic failure, or surgical consideration in the notes, flag it before it hits the payer. |
| 2 | Remove CPT 62291 and 72285 from your Aetna charge master if they appear there. These codes have no covered pathway under CPB 0733. Billing them to Aetna generates a denial, and there's no appeal path that changes that under this policy. |
| 3 | Verify prior authorization requirements at the plan level before scheduling. CPB 0733 sets medical necessity criteria, but individual Aetna plan contracts set prior auth requirements. Don't assume PA isn't needed because the procedure is covered. Call the plan or check Aetna's online portal for the specific plan before the procedure date. |
| 4 | Train your clinical documentation team on the three-part criteria. The physician note needs to explicitly state: (1) the severity and persistence of LBP, (2) the MRI findings showing abnormal interspaces, and (3) what prior diagnostics were performed and why they were insufficient. Vague notes create claim denial risk even when the patient genuinely meets criteria. |
| 5 | Match your ICD-10 coding to the approved code list. With 57 diagnosis codes in scope, there's real risk of using a code that looks right but isn't on Aetna's covered list. Cross-reference the full ICD-10 table below before submitting. M54.50–M54.59 for low back pain and M51.360–M51.379 for disc degeneration are the most common — but verify the specific code your coder selects appears in the policy. |
| 6 | Flag functional anesthetic discography separately. The policy notes that CPT 62290 and 72295 are not covered for functional anesthetic discography. If your practice performs this variant, it doesn't qualify for reimbursement under this policy, regardless of diagnosis. Confirm with your compliance officer whether this distinction affects your patient mix. |
If you're uncertain how this policy interacts with your specific Aetna contracts or your case mix, talk to your billing consultant or compliance officer before the September 26 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 Discography Under CPB 0733
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 62290 | CPT | Injection procedure for discography, each level; lumbar (not covered for functional anesthetic discography) |
| 72295 | CPT | Discography, lumbar, radiological supervision and interpretation (not covered for functional anesthetic discography) |
Not Covered CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 62291 | CPT | Injection procedure for discography, each level; cervical or thoracic | Not covered for any indication listed in CPB 0733 |
| 72285 | CPT | Discography, cervical or thoracic, radiological supervision and interpretation | Not covered for any indication listed in CPB 0733 |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| M43.06–M43.07 | Acquired spondylolisthesis, lumbar/lumbosacral region |
| M43.16–M43.17 | Acquired spondylolisthesis, lumbar/lumbosacral region |
| M46.46–M46.47 | Discitis, lumbar/lumbosacral region |
| M47.16 | Other spondylosis with myelopathy, lumbar/lumbosacral region |
| M47.816 | Lumbar spondylosis without myelopathy |
| M47.817 | Lumbosacral spondylosis without myelopathy |
| M48.061–M48.07 | Spinal stenosis, lumbar/lumbosacral region |
| M51.06 | Intervertebral disc disorder with myelopathy, lumbar region |
| M51.16–M51.17 | Degeneration of lumbar/lumbosacral intervertebral disc |
| M51.26 | Other intervertebral disc displacement, lumbar region |
| M51.27 | Other intervertebral disc displacement, lumbosacral region |
| M51.360–M51.369 | Other intervertebral disc degeneration, lumbar region |
| M51.370–M51.379 | Other intervertebral disc degeneration, lumbosacral region |
| M51.46 | Schmorl's nodes, lumbar region |
| M51.47 | Schmorl's nodes, lumbosacral region |
| M51.86–M51.87 | Other specified disc disorders, lumbar/lumbosacral region |
| M54.16–M54.17 | Radiculopathy, lumbar/lumbosacral region |
| M54.30–M54.42 | Sciatica |
| M54.50–M54.59 | Low back pain |
| M96.1 | Postlaminectomy syndrome, not elsewhere classified |
| S33.100+–S33.141+ | Dislocation of lumbar vertebra |
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