33615 Insurance Policy Changes

Cardiopulmonary Exercise Testing (CPB 0825, reviewed 2025-12-03)

Aetna has updated its Cardiopulmonary Exercise Testing (CPET) policy (CPB 0825, effective 2025-12-03) to define medical necessity criteria and clarify covered versus experimental indications. CPT 94621 is covered only when specific clinical conditions are met (e.g., post-thromboendarterectomy evaluation, exercise prescription for cardiac/pulmonary rehabilitation, CHF transplant evaluation, congenital heart disease assessment, Long COVID evaluation). CPET is classified as experimental for numerous conditions including first-line diagnostics, routine pre-operative assessment, cystic fibrosis, and dystrophinopathies. Billing teams must implement prior authorization checks and ensure claims include qualifying diagnoses.