A4558 Insurance Policy Changes

Organ Prolapse: Selected Procedures (CPB 0858, reviewed 2025-12-24)

Aetna's updated Organ Prolapse policy (CPB 0858, effective 2025-12-24) establishes medical necessity coverage for five specific procedures including laparoscopic suture rectopexy, sacrocolpopexy, and tension-free vaginal tape surgery, while classifying ten additional procedures and technologies as experimental/investigational. Billing teams must update systems to deny claims for non-covered experimental procedures and ensure prior authorization documentation aligns with the five covered interventions.