Alzheimer's Disease: Experimental, Investigational, or Unproven Treatment — CPB 0788 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0788 governing experimental and investigational Alzheimer's disease treatments, effective November 21, 2025. This update expands the exclusion list and affects dozens of CPT codes — including 0780T, 36514, 36516, 61863, and 62180–62245 series — that your billing team may be submitting for Aetna members with an AD diagnosis.

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Aetna Alzheimer's Disease Coverage Policy and Medical Necessity Requirements 2025

The Aetna Alzheimer's disease coverage policy under CPB 0788 Aetna system is not a coverage policy — it is an exclusion policy. Every treatment on this list gets denied as experimental, investigational, or unproven. There are no covered indications within this bulletin itself.

Medical necessity arguments won't save these claims. Aetna's position is that the clinical evidence does not establish effectiveness for any of the 68+ treatments listed. That's the standard language, but the practical result is a hard denial every time.

The real billing risk here is inadvertent submission. A neurologist orders focused ultrasound, a stem cell infusion, or a GLP-1 agonist for a patient with a documented Alzheimer's diagnosis — and nobody flags the Aetna AD exclusion before the claim goes out. That's where claim denial exposure lives.

Prior authorization won't help here either. These treatments aren't subject to prior authorization review — they're excluded outright. Submitting a prior auth request just delays the inevitable denial and adds administrative cost. Reimbursement is not available for any treatment on this list when billed for an AD indication.

Aetna Alzheimer's Disease Exclusions and Non-Covered Indications

This is where CPB 0788 does all its work. Aetna lists 68 treatments — explicitly noting the list is not all-inclusive — as experimental, investigational, or unproven for Alzheimer's disease. That "not all-inclusive" language matters. A treatment not on this list isn't automatically covered.

The exclusions span a wide clinical range. Some are obvious — investigational monoclonal antibodies like bapineuzumab, crenezumab, semorinemab, and solanezumab. Others will surprise your providers. GLP-1 receptor agonists like liraglutide are excluded. Statins are excluded. Celecoxib (Celebrex), levetiracetam, and metformin are all on the list.

This creates a practical problem for billing teams. These are drugs your providers prescribe routinely for other indications. If a patient has both an AD diagnosis and, say, diabetes, and the claim includes a GLP-1 agonist — the diagnosis coding matters enormously. Bill it with an AD primary diagnosis, and you've got an exclusion problem.

The procedural exclusions are equally broad. Deep brain stimulation, transcranial magnetic stimulation, vagus nerve stimulation, and focused ultrasound are all excluded when the indication is Alzheimer's disease. Fecal microbiota transplantation (CPT 0780T and 44705) is on the list. So is plasma exchange and hemapheresis (CPT 36514 and 36516). Hyperbaric oxygen therapy, photobiomodulation, and light therapy are excluded. Even music therapy, therapeutic touch, and Melissa oil aromatherapy made the list — which tells you how broadly Aetna is drawing the boundary.

Stem cell therapy covers the full spectrum: adipose tissue-derived stem cells, bone marrow-derived mesenchymal stem cells, and MSC-derived extracellular vesicles. CPT codes 38240, 38241, and 38242 are all captured under this exclusion.

The continuous drainage of cerebrospinal fluid exclusion pulls in a massive range of CPT codes — the 62180 through 62245 series of CSF shunt codes. That's dozens of codes in a single exclusion. If your team performs CSF-related procedures on patients with AD diagnoses, every one of those codes is at risk.

Coverage Indications at a Glance

Aetna Alzheimer's Disease Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Alzheimer's Disease Treatment Under CPB 0788

Not Covered / Experimental CPT Codes

All codes below are considered experimental, investigational, or unproven by Aetna when billed for Alzheimer's disease indications under CPB 0788.

Note: The policy data includes 116 total CPT codes and 64 HCPCS codes. The full code set is available in the complete CPB 0788 bulletin. The codes above represent the primary procedural categories with the highest claim denial risk for Alzheimer's disease billing.