S9359 Insurance Policy Changes

Tuberculosis Testing (CPB 0471, reviewed 2026-07-23)

Aetna has updated its tuberculosis testing policy (CPB 0471, effective 2026-07-23) to clarify coverage for multiple testing methodologies including Mantoux skin test, QuantiFERON tests, rapid molecular testing for drug-resistant TB, and urine-based lipoarabinomannan antigen testing for HIV+ patients. The policy explicitly excludes coverage for experimental tests including AI screening, biomarker-based non-sputum tests, breath tests, CRISPR-TB blood tests, and whole genome sequencing. Billing teams must ensure claims are submitted with correct CPT codes and that claims for excluded experimental tests are rejected or not submitted.