Eladocagene Exuparvovec-tneq (Kebilidi) — CPB 1073 | AETNA Coverage Update

Aetna modified CPB 1073 covering eladocagene exuparvovec-tneq (Kebilidi) gene therapy, effective September 26, 2025. Here's what billing teams need to do.

Aetna, a CVS Health company, updated its Kebilidi coverage policy under CPB 1073 Aetna system. This policy governs eladocagene exuparvovec-tneq (Kebilidi) — a gene therapy for aromatic L-amino acid decarboxylase (AADC) deficiency, coded as E70.81 — across commercial medical plans. The change carries high financial exposure. Kebilidi is a one-time infusion with a list price exceeding $4 million, and the billing requirements around it are specific and unforgiving.

Quick-Reference Table

Aetna Kebilidi Coverage Criteria and Medical Necessity Requirements 2025

The Aetna Kebilidi coverage policy under CPB 1073 centers on two hard requirements. First, precertification is mandatory for all Aetna participating providers and members in applicable plan designs — no exceptions. Second, the infusion must happen at an Aetna Institutes® Gene Based, Cellular and Other Innovative Therapy (GCIT®) Network facility, unless the member's specific plan has waived that requirement.

These aren't soft guidelines. They're hard stops. A claim for Kebilidi that bypasses either of these requirements will generate a claim denial, and appealing a $4 million gene therapy denial is not where you want to spend your time.

The medical necessity determination under this coverage policy ties directly to the diagnosis. ICD-10-CM E70.81 — aromatic L-amino acid decarboxylase deficiency — is the primary covered diagnosis. AADC deficiency is a rare autosomal recessive disorder. It causes severe neurological impairment from infancy, including hypotonia, oculogyric crises, and developmental delay. Kebilidi delivers a functional copy of the DDC gene directly into the brain via stereotactic neurosurgical infusion.

That surgical delivery method is why CPT codes 61781 and 61782 (stereotactic computer-assisted navigational procedures, cranial intradural and extradural) are central to this policy. These codes cover the neurosurgical procedure that places the gene therapy into the putamen. They don't stand alone — they pair with imaging (CPT 70551, 70552, 70553 for brain MRI) and a set of pre-infusion testing codes that Aetna now formally includes in its billing guidelines.

Prior authorization requirements here are strict. Call (866) 752-7021 or fax (888) 267-3277. For Statement of Medical Necessity forms, use the Specialty Pharmacy Precertification portal on Aetna's provider site. Do this before the member is scheduled — not after.

The reimbursement pathway for Kebilidi flows through the facility and professional components tied to the neurosurgical infusion and pre-treatment workup. Your billing team should understand that the anti-AAV2 antibody testing codes — including CPT 82542 (column chromatography with mass spectrometry), CPT 86325 (immunoelectrophoresis of other fluids including CSF), and CPT 88108 (cytopathology, concentration technique) — represent required pre-treatment workup. They must be documented and billed correctly to support the medical necessity narrative.

Aetna Kebilidi Exclusions and Non-Covered Indications

The policy data doesn't include an explicit list of non-covered indications separate from the GCIT and precertification requirements. But the structure of this coverage policy is clear: coverage is conditioned on GCIT network site use and precertification approval.

If either condition fails, the treatment is effectively not covered — regardless of the clinical appropriateness of the infusion. That's a functional exclusion your billing team needs to treat as a hard rule, not a technicality.

The ICD-10 code structure in this policy also flags an important detail. The policy lists a wide range of infection-related codes — from T80.211A through T88.0XXS, transplant infection codes across T86 categories, and A00.0–B99.9 (infectious and parasitic diseases). These appear in the context of anti-AAV2 antibody monitoring and post-infusion infectious complication management. They are not additional covered indications for Kebilidi itself. Misusing them as primary diagnosis codes on a Kebilidi claim will generate a denial.

Coverage Indications at a Glance

Aetna Kebilidi Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Eladocagene Exuparvovec-tneq (Kebilidi) Under CPB 1073

CPT Codes Associated with This Policy

All 11 CPT codes above fall under the anti-AAV2 antibody and procedural workup grouping in CPB 1073. They represent the pre-treatment testing, surgical delivery, imaging, and post-treatment maintenance components of the Kebilidi therapy pathway.

Key ICD-10-CM Diagnosis Codes Under CPB 1073

The large block of infection and transplant-related ICD-10 codes reflects the post-infusion complication monitoring context built into this policy. They support documentation of infectious adverse events following gene therapy delivery — not primary billing diagnoses for the Kebilidi infusion itself.