High impact
Breast Biopsy Procedures (CPB 0269, reviewed 2026-05-14)
Aetna·Effective May 14, 2026
Aetna's updated breast biopsy policy (CPB 0269, effective 2026-05-14) clarifies coverage for minimally invasive image-guided breast biopsy procedures as medically necessary alternatives when BI-RADS category 4 or 5 lesions are detected. The policy also explicitly designates several newer technologies (pegulicianine fluorescence, magnetic seeds, SAVI SCOUT, MarginProbe) as experimental/investigational and NOT covered. Billing teams must ensure claims for covered biopsy codes (19081-19086, 19283-19288) meet BI-RADS criteria, and reject claims for non-covered experimental procedures.