Facial Nerve Paralysis — CPB 0745 | AETNA Coverage Update

Aetna modified CPB 0745 for facial nerve paralysis, effective November 1, 2025. Here's what billing teams need to know before submitting claims.

Aetna, a CVS Health company, updated its facial nerve paralysis coverage policy under CPB 0745 in the Aetna system. This policy governs facial nerve paralysis billing across a wide range of CPT codes — from blink reflex testing and gold weight implants to complex surgical procedures like microvascular muscle transfer and nerve grafting. If your team bills CPT 15756, 15758, 64905, 64907, or 64911 for Aetna patients, this update directly affects your reimbursement.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Facial Nerve Paralysis — CPB 0745
Policy Code	CPB 0745
Change Type	Modified
Effective Date	November 1, 2025
Impact Level	High
Specialties Affected	Neurology, Otolaryngology, Plastic & Reconstructive Surgery, Physical Medicine & Rehabilitation, Ophthalmology
Key Action	Audit all open authorizations and pending claims against the three-part surgical criteria before billing CPT 15756, 15758, 64905, 64907, 64911, 64912, and 64913

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Aetna Facial Nerve Paralysis Coverage Criteria and Medical Necessity Requirements 2025

The Aetna facial nerve paralysis coverage policy has three core areas of medical necessity, and the surgical criteria are strict. If your practice treats chronic facial paralysis, understand these gates before you build the authorization request.

Blink reflex testing for Bell's palsy diagnosis is covered without conditions. CPT codes for nerve conduction studies apply here — see CPB 0502 cross-reference if you need specifics on how Aetna handles the broader electrodiagnostic suite.

Gold weight eyelid implants for Bell's palsy are also covered without additional criteria. These are addressed separately under CPB 0366 for paralytic lagophthalmos, so check both policies if your ophthalmology team bills these procedures.

Facial surgery — including anastomosis with cranial nerve branches, fascia slings, muscle transposition, cross facial nerve grafting using sural nerve, and microvascular muscle transfer — requires all three of the following criteria:

#	Covered Indication Copy
1	Facial paralysis has persisted for more than 12 months
2	Facial paralysis has caused impaired functional deficit in mastication, speech, or vision
3	Electromyography (EMG) or electroneuronography (ENoG) shows no reasonable likelihood of spontaneous recovery

All three must be met. One out of three is a claim denial. Two out of three is still a claim denial.

The 12-month persistence requirement is the one most likely to catch billing teams off guard. Document the onset date clearly in the medical record and make sure your authorization request includes that date explicitly. The functional deficit requirement — mastication, speech, or vision — is narrow. Cosmetic or psychosocial impairment alone does not qualify. That distinction matters for prior authorization.

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Aetna Facial Nerve Paralysis Exclusions and Non-Covered Indications

The experimental list here is long, and several items on it are treatments your referring physicians may be actively recommending. That creates friction. Know the list.

Aetna considers the following treatments for Bell's palsy experimental, investigational, or unproven — meaning claims will be denied under CPB 0745. CPB 0745 does not address prior authorization processes. Check Aetna's prior authorization requirements separately to understand auth implications for these procedures:

The diagnostic exclusions are equally important. Aetna will not cover combined electrophysiological test batteries for Bell's palsy outcome prediction. Genetic analysis of facial muscle specimens is excluded. Blood level measurements of total and native thiol and disulphide activity as a pathogenetic marker are excluded. Neuromuscular ultrasound (CPT 76536) for Bell's palsy diagnosis is excluded.

This matters practically: a physician may order a multi-test electrodiagnostic workup to predict recovery. Aetna covers blink reflex testing alone for diagnosis — but the full battery for outcome prediction is not covered. Make sure your neurodiagnostic team is not bundling excluded tests into the diagnostic encounter.

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Coverage Indications at a Glance

⚠️ Note on CPT 69720, 69725, and 69955 (Facial Nerve Decompression): The CPB 0745 source code table groups these codes in the experimental/not-covered category. However, the policy narrative lists facial nerve decompression among the types of facial surgery that may qualify under the three-part surgical criteria. This is a direct conflict in the source data. Do not bill these codes for Bell's palsy or facial paralysis patients without verifying the current coverage position directly with Aetna. Contact Aetna provider relations or your billing consultant before submitting claims or auth requests for CPT 69720, 69725, or 69955.

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Aetna Facial Nerve Paralysis Billing Guidelines and Action Items 2025

Copy Action Items

If your practice has a high volume of facial nerve paralysis cases or uses a mix of these modalities, loop in your compliance officer before the November 1 effective date. The overlap between covered surgical procedures and the long experimental list creates real claim denial risk if your charge capture and auth workflows are not updated.

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CPT, HCPCS, and ICD-10 Codes for Facial Nerve Paralysis Under CPB 0745

Covered CPT Codes (When Selection Criteria Are Met)

Classification Conflict: CPT 69720, 69725, 69955

⚠️ The source code table for CPB 0745 places CPT 69720 (Decompression facial nerve, intratemporal; lateral to geniculate ganglion), 69725 (including medial to geniculate ganglion), and 69955 (Total facial nerve decompression and/or repair) in the experimental/not-covered group. The policy narrative, however, references facial nerve decompression among potentially covered surgical procedures when the three-part criteria are met. These two sections of the policy conflict directly. Do not place these codes in either the covered or experimental table without first verifying with Aetna. Contact Aetna provider relations before billing or submitting auth requests for these codes.

Not Covered / Experimental CPT Codes

Note: The policy data includes 107 total CPT codes and references additional covered codes beyond those listed here. Review the full policy at app.payerpolicy.org/p/aetna/0745. for the complete code set.

HCPCS and ICD-10 Codes

⚠️ Incomplete data notice: CPB 0745 includes 15 HCPCS codes and 1 ICD-10-CM code that were not available in the source data reviewed for this article. The tables above cover CPT codes only. Access the full CPB 0745 policy document directly through Aetna to get the complete HCPCS and ICD-10 code sets before submitting claims. Billing without those codes confirmed creates denial risk your team can avoid.

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