Ablative Procedures for Prostate Cancer — CPB 0843 | AETNA Coverage Update

Aetna modified CPB 0843, its ablative procedures for prostate cancer coverage policy, effective February 27, 2026. Here's what billing teams need to know.

Aetna, a CVS Health company, updated CPB 0843 to expand the list of procedures it considers experimental, investigational, or unproven for prostate cancer treatment. The update adds new codes and procedures to the non-covered list — including CPT codes 0941T, 0942T, and 0943T for the Voro Urologic Scaffold, and CPT 51721 and 55881/55882 for thermal ultrasound ablation. If your urology or oncology billing team submits claims with any of the 7 Category III (T-suffix) CPT codes, 7 standard CPT codes, and 1 HCPCS code tied to this policy, expect denials unless something changes in the clinical picture.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna
Policy	Ablative Procedures for Prostate Cancer
Policy Code	CPB 0843
Change Type	Modified
Effective Date	February 27, 2026
Impact Level	High
Specialties Affected	Urology, Radiation Oncology, Interventional Radiology, Oncology
Key Action	Audit charge capture for CPT 0582T, 0655T, 0738T, 0739T, 0941T–0943T, 51721, 55881, 55882, and HCPCS C9734 — all non-covered under this policy

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Aetna Prostate Cancer Ablation Coverage Criteria and Medical Necessity Requirements 2026

The short version: Aetna's prostate cancer ablation coverage policy under CPB 0843 covers almost nothing on the ablative side. The entire policy is structured as an exclusion list.

Aetna draws a hard line between established surgical approaches — radical prostatectomy, including perineal and retropubic approaches — and the newer ablative and focal therapy techniques. CPT 55810, 55812, 55815, 55840, 55842, 55845, 55868, and 55869 appear in the policy as related surgical reference codes. Those are your radical prostatectomy codes. The policy does not address their coverage determination directly — refer to applicable surgical coverage policies for those.

The ablative procedures — the ones driving the most clinical interest right now — are a different story. Aetna does not consider them medically necessary under this policy. That's the real issue here. These aren't prior authorization gray areas. They're flat denials at the coverage-policy level.

If your providers are offering these procedures as prostate cancer treatment, your patients may be getting services that Aetna has already decided it won't pay for. That's a significant financial exposure for your practice and potentially a surprise bill situation for the patient.

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Aetna Prostate Cancer Ablation Exclusions and Non-Covered Indications

This is where the policy does most of its work. Aetna classifies 12 distinct ablative procedures as experimental, investigational, or unproven for prostate cancer — both as primary therapy and as salvage therapy after prior treatment.

Water vapor thermotherapy covers CPT 53854 and 0582T. Aetna will not cover transurethral destruction of prostate tissue by radiofrequency-generated water vapor thermotherapy or high-energy water vapor thermotherapy. That includes Rezum and similar systems.

MRI-guided focal laser ablation — including the Visualase Laser Ablation System — and transperineal focal laser ablation — including the Tranberg Thermal Therapy System — both map to CPT 0655T. The source policy lists these as separate procedure descriptions under the same code. Both are non-covered under this policy.

Magnetic field induction ablation uses CPT 0738T for treatment planning and 0739T for the ablation itself. Both are non-covered. This technology is relatively new, and the policy is clear it doesn't meet medical necessity standards.

MRI-guided transurethral ultrasound ablation (TULSA) maps to CPT 55881 and 55882, plus CPT 51721 for transducer insertion. These three codes are all non-covered. HCPCS C9734 — focused ultrasound ablation with MRI guidance — is also explicitly excluded.

Irreversible electroporation (NanoKnife), billed under CPT 55877, is non-covered under this policy. Aetna points to CPB 0828 for more detail on that technology.

Vascular targeted photodynamic therapy uses CPT 96570 and 96571. Both are excluded. These codes cover photodynamic therapy by endoscopic light application, and Aetna won't reimburse them for prostate cancer treatment.

The Voro Urologic Scaffold is a new addition that billing teams may not have seen before. Aetna classifies it as a supply incidental to surgery — not separately reimbursable. CPT 0941T (insertion), 0942T (removal and replacement), and 0943T (removal) are all non-covered. The policy is explicit: the scaffold is bundled into the surgical procedure, not billed separately.

Focal thermo-ablative therapy for oligometastatic prostate cancer (OMPC) and metastasis-directed therapy for oligo-metastatic or oligo-progressive disease are also non-covered. For symptomatic metastatic disease, Aetna refers to CPB 0100 (cryoablation) and CPB 0492 (radiofrequency tumor ablation) — not CPB 0843.

Dual-fiber laser ablation and photothermal ablation with copper sulfide nanoplates round out the list. No specific CPT codes map directly to those yet, but the clinical descriptions should be enough to flag them in your workflow.

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Coverage Indications at a Glance

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Aetna Prostate Cancer Ablation Billing Guidelines and Action Items 2026

The effective date of February 27, 2026 has passed. If you haven't already acted on this policy, do it now.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Prostate Cancer Ablation Under CPB 0843

Not Covered / Experimental CPT Codes

Other CPT Codes Referenced in CPB 0843 (Related Surgical Codes — Coverage Not Addressed in This Policy)

Not Covered HCPCS Codes

Code	Description Copy
C9734	Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance imaging guidance

Key ICD-10-CM Diagnosis Codes

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