TL;DR: Aetna, a CVS Health company, modified CPB 0827 covering electric tumor treatment fields (ETTF), effective February 19, 2026. Billing teams need to confirm nine medical necessity criteria are documented before billing E0766 and CPT 1025T — and re-authorization every 90 days is not optional.
This Aetna electric tumor treatment fields coverage policy is one of the tighter specialty device policies on the books. CPB 0827 Aetna governs reimbursement for ETTF therapy — marketed as Optune — used in newly diagnosed glioblastoma multiforme (GBM). The primary billing codes are HCPCS E0766 (the device itself), A4555 (replacement electrodes), and CPT 1025T (dosimetry and delivery-simulation modeling). If your team bills any of these, read this carefully before your next claim goes out.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna |
| Policy | Electric Tumor Treatment Fields — CPB 0827 |
| Policy Code | CPB 0827 |
| Change Type | Modified |
| Effective Date | February 19, 2026 |
| Impact Level | High |
| Specialties Affected | Neuro-oncology, neurosurgery, radiation oncology, durable medical equipment suppliers |
| Key Action | Audit active ETTF cases for all nine medical necessity criteria and verify 90-day re-authorization schedules before billing E0766 |
Aetna Electric Tumor Treatment Fields Coverage Criteria and Medical Necessity Requirements 2026
Aetna's coverage policy for ETTF is narrow by design. Exactly one diagnosis qualifies: histologically confirmed WHO grade IV astrocytoma — newly diagnosed, supratentorial glioblastoma. Not recurrent GBM. Not other high-grade gliomas. Newly diagnosed, supratentorial, WHO grade IV. That distinction alone drives a large share of claim denials on this code set.
To meet medical necessity under CPB 0827, a member must satisfy all nine of the following criteria simultaneously:
| # | Covered Indication |
|---|---|
| 1 | Diagnosis: Histologically confirmed WHO grade IV astrocytoma (newly diagnosed, supratentorial glioblastoma) |
| 2 | Prior treatment: Maximal debulking surgery (when feasible), followed by concomitant chemotherapy and radiotherapy |
| 3 | Therapy timing: ETTF initiated within seven weeks of the last dose of concomitant chemotherapy or radiotherapy — whichever is later |
| 4 | No progression: No evidence of disease progression by RANO (Response Assessment in Neuro-Oncology) criteria |
| 5 | Performance status: Karnofsky Performance Score (KPS) of at least 70 |
| 6 | Adherence commitment: Member will use ETTF for an average of 18 hours per day |
| 7 | Age: 22 years or older |
| 8 | Pregnancy status: Confirmed non-pregnant for women of childbearing age |
| 9 | Device exclusion: No intracranial shunt or other implanted intracranial device |
Every one of these must be documented before you bill E0766. Missing a single criterion — say, a KPS that isn't recorded in the chart, or a start date that falls outside the seven-week window — will result in a claim denial. Build a checklist into your prior authorization workflow now.
The prior authorization requirement doesn't end at initial approval. Continued coverage of ETTF beyond the first three months requires a clinical re-evaluation by the treating practitioner. This must happen no sooner than day 60 and no later than day 91 after therapy starts. Re-authorization is then required every three months after that, based on the same parameters.
That 60-to-91-day window is tight. If your team misses it, you're billing without authorization — and that's a real exposure on durable medical equipment claims. Calendar every re-auth date the day you submit the initial claim.
Aetna Electric Tumor Treatment Fields Exclusions and Non-Covered Indications
Aetna classifies ETTF as experimental, investigational, or unproven for everything outside of newly diagnosed supratentorial GBM. The list of non-covered tumor types is explicit and worth reviewing if your oncology team is running clinical trials or exploring off-label use.
Non-covered indications include ETTF devices used to treat:
| # | Excluded Procedure |
|---|---|
| 1 | Breast cancer |
| 2 | Lung cancer and non-small cell lung cancer (NSCLC) |
| 3 | Melanoma |
| 4 | Osteosarcoma |
| 5 | Ovarian cancer |
| 6 | Pleural mesothelioma |
| 7 | Pancreatic cancer |
| 8 | Salivary gland tumors (including parotid adenoid cystic carcinoma) |
| 9 | Solid tumor brain metastases |
Aetna also classifies as experimental any combined ETTF therapy paired with chemotherapy or immunotherapy agents other than temozolomide. The specific agents listed as non-covered include bevacizumab, cisplatin, paclitaxel, pemetrexed, lomustine, doxorubicin, cyclophosphamide, dacarbazine, capecitabine, 6-thioguanine, celecoxib, and zinc oxide nanoparticles — across cancer types including breast, colorectal, and hepatocellular carcinoma.
This matters for billing because ICD-10 codes for these diagnoses appear in CPB 0827's code list — but they're there to define what Aetna won't cover. If you're submitting E0766 with a pancreatic cancer diagnosis, expect a denial. The coverage policy does not support it.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Newly diagnosed supratentorial GBM (WHO grade IV astrocytoma) | Covered | E0766, A4555, 1025T, J8700, J9328 | All nine criteria must be met; prior authorization required |
| GBM — continued therapy beyond 90 days | Covered with re-auth | E0766 | Re-evaluation required between day 60–91; re-auth every 3 months |
| Recurrent or progressive GBM | Not Covered | — | Must show no progression by RANO criteria |
| ETTF for breast, lung, melanoma, osteosarcoma, ovarian, mesothelioma, pancreatic, salivary gland tumors, solid tumor brain metastases | Experimental / Not Covered | — | Explicitly excluded; claim denial expected |
| ETTF combined with non-temozolomide chemo/immunotherapy | Experimental / Not Covered | — | Includes bevacizumab, pemetrexed, paclitaxel, and others |
Aetna Electric Tumor Treatment Fields Billing Guidelines and Action Items 2026
The real issue with electric tumor treatment fields billing is the combination of strict upfront criteria and a rolling re-authorization cycle. Both create denial risk if your team doesn't have a structured workflow.
| # | Action Item |
|---|---|
| 1 | Build a nine-point checklist into your prior auth intake form. Every field that maps to the nine criteria — diagnosis confirmation, KPS score, RANO status, therapy start date relative to last chemo or radiation dose, age, pregnancy status, intracranial device status — must be collected before submitting authorization for E0766. Don't let an incomplete chart slip through. |
| 2 | Lock in the therapy start date on day one. The seven-week timing rule is strict. Count back from the last dose of concomitant chemo or radiation, add 49 days, and that's your hard cutoff. Document the start date in the authorization request. If you're close to the edge, flag it immediately. |
| 3 | Calendar every re-authorization at the time of initial auth approval. Set your first re-auth reminder for day 55 — five days before the earliest allowed re-evaluation date. The treating physician must conduct an in-person clinical re-evaluation between day 60 and day 91. Missing this window means billing without authorization. |
| 4 | Confirm adherence documentation is in the chart before each re-auth. Aetna's definition of adherence is specific: an average of 18 hours per day of device use, excluding days when the treating practitioner has documented a medical reason to limit or interrupt treatment. "Patient reports compliance" won't hold up. You need objective evidence reviewed by the treating physician. |
| 5 | Verify ICD-10 coding before submitting. The covered diagnosis is C71.x — malignant neoplasm of brain, supratentorial — paired with the correct WHO grade IV astrocytoma documentation. The policy lists 163 ICD-10-CM codes, most of them to define non-covered indications. Submitting E0766 with an excluded diagnosis code is an automatic claim denial. |
| 6 | Confirm temozolomide is the only concurrent chemotherapy. If the treating oncologist adds a second agent — bevacizumab is the most common scenario in GBM — flag it for your compliance officer before billing. Aetna treats combined ETTF and non-temozolomide therapy as experimental. J8700 (oral temozolomide, 5 mg) and J9328 (injectable temozolomide, 1 mg) are the only chemotherapy codes covered alongside ETTF under this policy. |
| 7 | Review all active ETTF cases before February 19, 2026. The effective date of this modification is February 19, 2026. Pull every open ETTF case and confirm it meets the current criteria under CPB 0827. If you're unsure how this applies to a specific patient's situation, loop in your compliance officer before that 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 Electric Tumor Treatment Fields Under CPB 0827
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 1025T | CPT | Alternating electric fields dosimetry and delivery-simulation modeling, creation and selection of patient-specific treatment parameters |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| E0766 | HCPCS | Electrical stimulation device used for cancer treatment, includes all accessories, any type |
| A4555 | HCPCS | Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only |
| J8700 | HCPCS | Temozolomide, oral, 5 mg |
| J9328 | HCPCS | Injection, temozolomide, 1 mg |
Key ICD-10-CM Diagnosis Codes
The full CPB 0827 code list includes 163 ICD-10-CM codes. The majority define non-covered indications — tumor types Aetna considers experimental for ETTF. The table below includes a representative sample from the policy data. Your billing team should reference the full policy at payerpolicy.org for the complete list.
| Code | Description | Coverage Status |
|---|---|---|
| C08.0–C08.9 | Malignant neoplasm of other and unspecified major salivary glands | Not Covered (Experimental) |
| C11.0–C11.9 | Malignant neoplasm of nasopharynx | Not Covered (Experimental) |
| C15.3–C15.9 | Malignant neoplasm of esophagus | Not Covered (Experimental) |
| C16.0–C16.9 | Malignant neoplasm of stomach | Not Covered (Experimental) |
| C18.0–C18.9 | Malignant neoplasm of colon | Not Covered (Experimental) |
| C19–C21.8 | Malignant neoplasm of rectosigmoid junction, rectum, anus and anal canal | Not Covered (Experimental) |
| C22.0 | Liver cell carcinoma | Not Covered (Experimental) |
| C22.1 | Intrahepatic bile duct carcinoma | Not Covered (Experimental) |
| C23–C24.9 | Malignant neoplasm of gallbladder and biliary tract | Not Covered (Experimental) |
| C25.0–C25.9 | Malignant neoplasm of pancreas | Not Covered (Experimental) |
| C31.0–C31.9 | Malignant neoplasm of accessory sinuses (paranasal) | Not Covered (Experimental) |
| C33–C34.92 | Malignant neoplasm of trachea, bronchus, and lung (NSCLC) | Not Covered (Experimental) |
| C37 | Malignant neoplasm of thymus | Not Covered (Experimental) |
| C41.0–C41.1 | Malignant neoplasm of bone and articular cartilage | Not Covered (Experimental) |
The covered diagnosis — newly diagnosed supratentorial GBM — maps to C71.x (malignant neoplasm of brain) with supporting pathology documentation confirming WHO grade IV astrocytoma. Make sure your ICD-10 selection reflects the exact anatomical site and histologic confirmation required by the policy.
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