High impact
Prostate Biopsy (CPB 0698, reviewed 2026-03-02)
Aetna·Effective Mar 2, 2026
Aetna updated its prostate biopsy medical necessity criteria (CPB 0698), effective immediately. The policy now specifies which biopsy techniques are covered (transperineal stereotactic saturation, TRUS-guided, and MRI-guided/fusion approaches) based on specific clinical indications, while designating several newer technologies (AI-based mapping, contrast-enhanced ultrasound, liquid biopsy, micro-ultrasound, and spectral analysis) as experimental and non-covered. Billing teams must update claim processing to enforce these new coverage rules and deny claims for non-covered techniques.