Selected Kidney Function Tests — CPB 0775 | AETNA Coverage Update

Aetna modified CPB 0775 covering selected kidney function tests, effective February 14, 2026. Here's what changes for billing teams.

Aetna, a CVS Health company, updated its kidney function testing coverage policy under CPB 0775 in the Aetna Clinical Policy Bulletin system. This modification explicitly classifies eight CPT codes — including 0105U, 0259U, 0355U, 0384U, 0385U, 0407U, 0602T, and 0603T — as non-covered for the indications listed in the bulletin. If your practice bills any of these codes for patients with CKD, diabetic kidney disease, or GFR assessment, this policy change has direct financial exposure for your claims.

Quick-Reference Table

Aetna Kidney Function Tests Coverage Criteria and Medical Necessity Requirements 2026

The Aetna kidney function tests coverage policy under CPB 0775 is blunt: every test listed in this bulletin is experimental, investigational, or unproven. There are no coverage criteria to meet. There is no prior authorization pathway that unlocks reimbursement for these codes. Aetna's position is that the clinical evidence simply hasn't established the effectiveness of these tests.

This matters because several of these tests have been actively marketed to nephrologists and endocrinologists as next-generation tools for managing CKD and diabetic kidney disease. KidneyIntelX, NaviDKD, PromarkerD — these aren't obscure tests. They're being promoted to exactly the specialties that see the highest concentration of Aetna commercial members with diabetes and CKD.

The medical necessity argument does not apply here the way it does with coverage policies that have tiered criteria. Aetna isn't saying these tests need more documentation or a specific ICD-10 to get paid. They're saying the tests don't meet the evidence bar for coverage at all. That's a harder wall to work around, and it means any claim submitted with these codes against an Aetna plan faces a flat denial — not a documentation fix.

If your practice has been ordering these tests assuming eventual coverage, or if your lab has been billing them under the assumption that medical necessity documentation would carry the claim, you need to stop that practice before February 14, 2026.

Aetna Kidney Function Tests Exclusions and Non-Covered Indications

Every test addressed in CPB 0775 falls under the experimental/investigational/unproven classification. There are no covered indications in this policy — it is exclusion all the way through.

Here's what Aetna specifically calls out:

APOL1 renal risk variant genotyping (CPT 0355U) — This covers both blood and buccal mucosa sample types. Aetna isn't covering this regardless of how the specimen is collected or what G1/G2 variants are being tested.

GFR NMR test (CPT 0259U) — This is the nuclear magnetic resonance spectroscopy-based GFR assessment measuring myo-inositol, dimethyl sulfone, valine, and creatinine. The fact that it uses multiple metabolites and advanced spectroscopy doesn't change Aetna's read on the evidence.

KidneyIntelX and IntelxDKD (CPT 0105U, 0407U) — Both products from RenalytixAI are excluded. These electrochemiluminescent immunoassay tests for predicting renal decline in type 2 diabetes patients are non-covered under this policy.

NaviDKD and PromarkerD (CPT 0384U, 0385U) — Both tests for predicting kidney disease in patients with diabetes are explicitly named. These are the multiplex assays measuring biomarkers like carboxymethyllysine, methylglyoxal hydroimidazolone, apolipoprotein A4, and CD5 antigen-like.

RenalVysion — This Nephrocor test for diagnosing and monitoring kidney disease is also excluded. Note that this test doesn't appear to have its own dedicated CPT code listed in the covered or non-covered code table — but the test itself is called out by name in the policy language.

Transdermal GFR measurement (CPT 0602T, 0603T) — Both the single-measurement and monitoring versions using pyrazine-based fluorescent agents are non-covered. This is a device-based approach, and Aetna isn't recognizing it for reimbursement under any circumstance described in this policy.

The real issue here is that some of these products have FDA clearance or are CE marked. Clinicians assume FDA clearance signals payer coverage readiness. It doesn't. Aetna's coverage policy standard requires peer-reviewed evidence of clinical utility — not just analytical validity. These tests haven't crossed that line in Aetna's assessment.

Coverage Indications at a Glance

Aetna Kidney Function Tests Billing Guidelines and Action Items 2026

The billing guidelines here are straightforward, but the operational steps matter. Work through these before the effective date of February 14, 2026.

CPT, HCPCS, and ICD-10 Codes for Kidney Function Tests Under CPB 0775

Not Covered / Experimental CPT Codes

All eight CPT codes in this policy are classified as non-covered for the indications listed in CPB 0775. There are no covered CPT codes in this bulletin.

Key ICD-10-CM Diagnosis Codes

These are the diagnosis codes associated with the tests addressed in CPB 0775. They appear in the policy code table and represent the patient populations most likely to be ordered these tests.