TL;DR: Aetna, a CVS Health company, modified CPB 0844 — its fecal bacteriotherapy coverage policy — effective September 26, 2025. Here's what billing teams need to know before submitting claims under CPT 0780T, 44705, HCPCS G0455, or J1440.
This update to CPB 0844 in Aetna's system touches four billable codes and maps to 146 ICD-10 diagnosis codes spanning C. diff, IBD, neurological conditions, metabolic disorders, and more. The breadth of that diagnosis list is the real story here — fecal microbiota transplant (FMT) billing has gotten considerably more complex, and a claim denial is easy to trigger if your documentation doesn't match Aetna's selection criteria precisely.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Fecal Bacteriotherapy |
| Policy Code | CPB 0844 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Gastroenterology, Infectious Disease, Transplant Medicine, Neurology, Endocrinology, Oncology |
| Key Action | Audit ICD-10 pairings for CPT 0780T, 44705, HCPCS G0455, and J1440 against current CPB 0844 selection criteria before billing |
Aetna Fecal Bacteriotherapy Coverage Criteria and Medical Necessity Requirements 2025
The Aetna fecal bacteriotherapy coverage policy under CPB 0844 covers four codes — but only when selection criteria are met. That phrase does a lot of work. It means coverage isn't automatic for any of these codes, regardless of diagnosis.
All four codes (CPT 0780T, CPT 44705, HCPCS G0455, HCPCS J1440) fall into the "covered if selection criteria are met" bucket. Aetna hasn't made any of them blanket-covered or blanket-excluded. Medical necessity must be established for every claim.
The Aetna fecal bacteriotherapy coverage policy separates the procedure from the preparation. CPT 44705 covers preparation of the fecal microbiota for instillation, including assessment of the donor specimen. CPT 0780T covers instillation via rectal enema into the lower GI tract. HCPCS G0455 bundles both — preparation and instillation by any method, including assessment of the donor specimen. HCPCS J1440 covers the drug product itself: fecal microbiota, live - jslm, billed per 1 ml.
If your team bills both CPT 44705 and CPT 0780T together, watch for bundling edits. HCPCS G0455 appears to overlap both — that combination could generate a claim denial if payers flag it as duplicate billing. Check your charge capture logic before the September 26, 2025 effective date.
Prior authorization requirements aren't explicitly enumerated in the policy data provided. Given the breadth of covered indications and the experimental status of FMT for many conditions beyond C. diff, assume prior authorization is required for any indication outside of recurrent Clostridioides difficile. Confirm with Aetna's provider portal or your payer relations contact before submitting.
Fecal bacteriotherapy billing for Medicare members follows a different path. Aetna routes Medicare Part B criteria to a separate step-therapy page. If you're treating dual-eligible members or Medicare Advantage patients under an Aetna plan, don't assume commercial CPB 0844 criteria apply. Verify the member's plan type first.
Aetna Fecal Bacteriotherapy Exclusions and Non-Covered Indications
The policy data doesn't designate specific codes as explicitly non-covered or experimental for this update. Every listed code falls under "covered if selection criteria are met." But that doesn't mean everything is covered.
The real issue here is the ICD-10 code list. Aetna has mapped 146 diagnosis codes to CPB 0844 — including conditions like Alzheimer's disease (G30.x), Parkinson's disease (G20.A1–G20.C), autism spectrum disorder (F84.x), ADHD (F90.x), Tourette syndrome (F95.2), ALS (G12.21), obesity (E66.x), and diabetes mellitus (E08.00–E13.9). The clinical evidence supporting FMT for most of these indications is early-stage at best.
Mapping a diagnosis code to a policy doesn't mean Aetna covers FMT for that diagnosis. These codes appear in the policy — likely as part of the investigational/experimental framework — to delineate where FMT is not covered without meeting additional criteria. Billing CPT 0780T for a patient with Alzheimer's disease using G30.9 without solid medical necessity documentation and prior authorization is a denial waiting to happen.
If you're unsure how CPB 0844 applies to a specific diagnosis in your patient mix, talk to your compliance officer before the September 26, 2025 effective date. The gap between "code appears in the policy" and "code is covered" is where revenue leaks.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Clostridioides difficile enterocolitis (recurrent) | Covered (criteria-dependent) | A04.71, A04.72, CPT 0780T, 44705, HCPCS G0455, J1440 | Strongest evidence base; most likely to clear medical necessity review |
| Bacterial intestinal infection / GI dysbiosis | Covered (criteria-dependent) | A04.9, CPT 0780T, G0455 | Broader indication; documentation burden higher |
| Graft-versus-host disease | Covered (criteria-dependent) | D89.810–D89.813, CPT 0780T, G0455 | Common FMT use in transplant settings; prior auth likely required |
| Inflammatory bowel / colon malignancy | Covered (criteria-dependent) | C18.0–C18.9 | High scrutiny; ensure documented medical necessity |
| Immune thrombocytopenic purpura | Covered (criteria-dependent) | D69.3 | Emerging indication; prior auth strongly recommended |
| Diabetes mellitus | Covered (criteria-dependent) | E08.00–E13.9 | Investigational for metabolic indications; document carefully |
| Obesity / overweight | Covered (criteria-dependent) | E66.1–E66.9 | Likely experimental without specific criteria met |
| D-lactic acidosis | Covered (criteria-dependent) | E87.20–E87.29 | Niche indication; document clinical rationale thoroughly |
| Metabolic syndrome / insulin resistance | Covered (criteria-dependent) | E88.810–E88.819 | Emerging indication; expect heightened review |
| Autism spectrum disorder | Covered (criteria-dependent) | F84.0–F84.9 | Evidence base limited; expect prior auth and potential denial |
| ADHD | Covered (criteria-dependent) | F90.0–F90.9 | Limited clinical support for FMT; document carefully |
| Tourette syndrome | Covered (criteria-dependent) | F95.2 | Rare indication; prior auth required |
| ALS | Covered (criteria-dependent) | G12.21 | Investigational; strong documentation required |
| Parkinson's disease | Covered (criteria-dependent) | G20.A1–G20.C | Emerging gut-brain research; expect scrutiny |
| Alzheimer's disease | Covered (criteria-dependent) | G30.0–G30.9 | Very limited evidence; high denial risk without prior auth |
| Mild cognitive impairment / post-op cognitive dysfunction | Covered (criteria-dependent) | G31.84 | Low evidence base; document rationale explicitly |
Aetna Fecal Bacteriotherapy Billing Guidelines and Action Items 2025
These are the steps your billing team needs to take now — not after you see a denial.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 0780T, 44705, HCPCS G0455, and J1440 before September 26, 2025. Confirm each code is mapped to a valid ICD-10 from the CPB 0844 list. A diagnosis code that doesn't appear in the policy will trigger a claim denial automatically. |
| 2 | Resolve the G0455 bundling question before it hits a claim. HCPCS G0455 covers preparation AND instillation. If your billing team also submits CPT 44705 and CPT 0780T on the same claim, expect a bundling edit. Decide which code set you're billing — not both. |
| 3 | Establish prior authorization workflows for any non-C. diff FMT indication. The policy covers criteria-dependent indications across neurology, endocrinology, and oncology. None of those will sail through without prior authorization and documented medical necessity. Build those PA requests into your pre-service workflow now. |
| 4 | Separate commercial from Medicare billing. CPB 0844 applies to commercial plans only. Aetna Medicare Part B criteria are housed at a different URL and may differ significantly. Flag Medicare Advantage patients at the point of scheduling and verify criteria separately. |
| 5 | Update your J1440 billing to reflect unit-based billing. HCPCS J1440 bills per 1 ml of fecal microbiota, live - jslm. Confirm your billing team knows the dosing and unit conversion before submitting — this is a common reimbursement error on drug codes. |
| 6 | Review documentation templates for any neurological or metabolic FMT indications. If your practice is providing FMT for Parkinson's, Alzheimer's, autism, or metabolic syndrome, your documentation needs to explicitly support medical necessity under CPB 0844 criteria. Generic "FMT indicated" notes won't hold up to review. |
| 7 | If your volume in these non-C. diff indications is significant, loop in your compliance officer. The ICD-10 list is broad, the clinical evidence for many listed conditions is still developing, and Aetna's selection criteria will be the deciding factor on every one of these claims. Get ahead of it. |
| 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 Fecal Bacteriotherapy Under CPB 0844
Covered CPT and HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 0780T | CPT | Instillation of fecal microbiota suspension via rectal enema into lower gastrointestinal tract |
| 44705 | CPT | Preparation of fecal microbiota for instillation, including assessment of donor specimen |
| G0455 | HCPCS | Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen |
| J1440 | HCPCS | Fecal microbiota, live - jslm, 1 ml |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| A04.71 | Enterocolitis due to Clostridium difficile |
| A04.72 | Enterocolitis due to Clostridium difficile |
| A04.9 | Bacterial intestinal infection, unspecified [gastrointestinal dysbiosis] |
| C18.0–C18.9 | Malignant neoplasm of colon (multiple subsites) |
| D69.3 | Immune thrombocytopenic purpura [idiopathic thrombocytopenic purpura] |
| D89.810 | Acute graft-versus-host disease |
| D89.811 | Chronic graft-versus-host disease |
| D89.812 | Acute on chronic graft-versus-host disease |
| D89.813 | Graft-versus-host disease, unspecified |
| E08.00–E13.9 | Diabetes mellitus (multiple types and manifestations) |
| E66.1–E66.9 | Overweight and obesity (multiple codes) |
| E87.20–E87.29 | Acidosis [D-lactic acidosis] |
| E88.810–E88.819 | Metabolic syndrome [insulin resistance] |
| F84.0–F84.9 | Autistic disorder (multiple codes) |
| F90.0–F90.9 | Attention-deficit hyperactivity disorders (multiple codes) |
| F95.2 | Tourette syndrome |
| G12.21 | Amyotrophic lateral sclerosis |
| G20.A1–G20.C | Parkinson's disease (multiple codes) |
| G30.0–G30.9 | Alzheimer's disease (multiple codes) |
| G31.84 | Mild cognitive impairment [post-operative cognitive dysfunction] |
| + 66 additional ICD-10-CM codes | See full policy at CPB 0844 Aetna for the complete list |
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