Toxicology: Per- and Polyfluoroalkyl Substances (PFAS) Testing — CPB 1067 | AETNA Coverage Update

Aetna updated CPB 1067 on January 21, 2026, classifying all PFAS blood and urine testing as experimental and non-covered for Aetna members. Here's what billing teams need to do.

Aetna, a CVS Health company, now explicitly excludes PFAS toxicology testing — including CPT codes 0394U, 0457U, 0535U, 0589U, and 82542 — from coverage under CPB 1067 in the Aetna PFAS testing coverage policy. This update draws a hard line: no PFAS lab testing qualifies for reimbursement under any clinical indication listed in this bulletin, regardless of how it's coded or documented. If your practice or lab has been billing these codes to Aetna, expect denials starting now.

Quick-Reference Table

Aetna PFAS Testing Coverage Criteria and Medical Necessity Requirements 2026

The short version: there are no covered indications. Aetna's CPB 1067 coverage policy draws a single conclusion — PFAS testing is experimental and unproven for all clinical purposes.

The policy language says Aetna considers laboratory testing for per- and polyfluoroalkyl substances "experimental, investigational, or unproven for clinical evaluation and management of PFAS exposure or toxicity because the effectiveness of this approach has not been established." That language matters. It's not a prior authorization problem. It's not a missing modifier. Aetna is saying the clinical utility of PFAS testing hasn't been proven — full stop.

There is no medical necessity argument that unlocks coverage here. You can't write a stronger clinical note, add a more specific diagnosis code from the Z77 family, or document a more compelling exposure history to change this outcome. The coverage policy forecloses all clinical pathways.

This is the same pattern Aetna used when it drew a hard line on genetic testing panels before they were widely accepted — classify as experimental, list the codes, deny claims. The PFAS testing billing situation is identical.

Aetna PFAS Testing Exclusions and Non-Covered Indications

Every PFAS testing indication in this policy falls under the experimental designation. That includes blood testing, urine testing, and panel-based approaches like PFAS Forever Chemicals Panel 2.

Specific substances named in the exclusion include perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS). Those are two of the most commonly tested PFAS compounds. Their inclusion makes clear that Aetna isn't leaving room for a "just test for PFOA" workaround.

The excluded codes cover both the newer proprietary lab analysis (PLA) codes and the general chromatography code 82542. Labs that use column chromatography or liquid chromatography-mass spectrometry (LC/MS) methods to detect PFAS — and bill under 82542 — are also explicitly out of scope for reimbursement. There's no backdoor here through a general chemistry code.

Coverage Indications at a Glance

Aetna PFAS Testing Billing Guidelines and Action Items 2026

CPT, HCPCS, and ICD-10 Codes for PFAS Testing Under CPB 1067

Not Covered / Experimental CPT Codes

These five codes are explicitly listed as non-covered for all PFAS testing indications under CPB 1067. None of them have a covered pathway.

Key ICD-10-CM Diagnosis Codes Listed in CPB 1067

These codes define the clinical scenarios Aetna considered — and explicitly excluded. Using them on a PFAS testing claim does not establish medical necessity.

Note: CPB 1067 lists 91 total ICD-10-CM codes. The complete list covers the full Z77.xx range of chemical exposure diagnosis codes plus T65.91XA–T65.91XS and Z13.88. See the full policy at PayerPolicy for the complete code set.

One more practical note: the four PLA codes (0394U, 0457U, 0535U, and 0589U) are relatively new to the CPT code set. Some practices may have these loaded in their charge master but haven't yet mapped a payer-specific coverage rule to them. The January 21, 2026 effective date is your trigger to fix that now — not after your first denial hits.