Brexanolone (Zulresso) - 0951 — CPB 0951 | AETNA Coverage Update

Aetna modified CPB 0951 for brexanolone (Zulresso), effective February 14, 2026 — but the drug was pulled from the U.S. market in April 2025. Here's what billing teams need to know before a claim denial costs you.

Aetna updated its brexanolone coverage policy under CPB 0951 to reflect the market withdrawal of Zulresso. The policy governs HCPCS code J1632 (injection, brexanolone, 1 mg) and infusion administration codes 96365–96368. Any claim submitted for brexanolone billing after April 2025 is heading toward a wall — but the coverage criteria remain in the policy, which means your billing team needs to understand exactly where the lines are.

Quick-Reference Table

Aetna Brexanolone Coverage Criteria and Medical Necessity Requirements 2026

The real question for billing teams isn't whether Zulresso is still available. It isn't. The question is whether you have any open claims, prior authorizations, or encounters from before April 2025 that you still need to close correctly.

Aetna's coverage policy under CPB 0951 allows a one-time infusion of brexanolone for moderate to severe postpartum depression (PPD). The member must be 15 years of age or older. Three conditions must all be met at once.

First, the member must have a documented major depressive episode. That episode must have started no earlier than the third trimester of pregnancy and no later than four weeks following delivery. Aetna requires documentation using standardized rating scales — the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), or Montgomery-Åsberg Depression Rating Scale (MADRS) all qualify.

Second, the member must be six months postpartum or less at the time of infusion.

Third — and this is the hard stop — Aetna covers only one infusion per pregnancy or childbirth. No repeat courses within the same pregnancy or childbirth event.

Prior authorization is required. This isn't optional language. Aetna requires precertification of brexanolone for all participating providers and members in applicable plan designs. Call (866) 752-7021 or fax (888) 267-3277 to initiate. Statement of Medical Necessity forms are available through Aetna's Specialty Pharmacy Precertification portal.

For any encounter billed before April 2025, medical necessity documentation needs to match these criteria exactly. A claim denial on an otherwise covered infusion — because the depression onset wasn't documented in the third trimester or the member was beyond six months postpartum — is avoidable. Check your records before you close those encounters.

This coverage policy applies to commercial medical plans. Medicare criteria follow a separate path. Check Aetna's Medicare Part B guidelines if you have Medicare Advantage exposure.

Aetna Brexanolone Exclusions and Non-Covered Indications

Aetna's position here is categorical: all indications other than moderate to severe PPD meeting the specific criteria above are experimental, investigational, or unproven. There are no gray areas in the policy language.

That means brexanolone for any other depressive disorder — major depressive disorder outside the postpartum window, bipolar depression, treatment-resistant depression — gets no coverage. Don't bill J1632 with a primary diagnosis outside F53.0 (postpartum depression) and expect reimbursement. You won't get it.

The ICD-10 code set in this policy is broad (more on that in the codes section below), but the clinical criteria are narrow. The wide diagnosis code range reflects what Aetna tracks for monitoring purposes, not an expansion of covered indications.

Coverage Indications at a Glance

Aetna Brexanolone Billing Guidelines and Action Items 2026

The drug is off the market. That doesn't mean your billing work is done. Here's what to do now.

If you're dealing with a complex prior authorization dispute or a denied claim from 2024 or early 2025, talk to your compliance officer before submitting an appeal. The criteria are specific enough that documentation gaps are the most common failure point.

CPT, HCPCS, and ICD-10 Codes for Brexanolone Under CPB 0951

Covered HCPCS Codes (When Selection Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

Aetna's CPB 0951 references a broad set of ICD-10-CM codes. The covered indication is F53.0. The remaining codes appear to reflect monitoring or exclusion tracking — they do not expand covered indications beyond PPD.

The neurological code ranges (G10–G80) in this policy are notable. They don't correspond to any covered indication for brexanolone. These likely appear in the policy's code set for tracking or exclusion documentation purposes. Don't let their presence suggest brexanolone has any covered application in epilepsy, movement disorders, or neurodegenerative conditions. It doesn't under this coverage policy.