CommercialCoverageHigh impact
Tumor Chemosensitivity Assays (CPB 0245, reviewed 2026-04-13)
Aetna·Oncology, Hematology, Pathology·Medical Policy
Effective date
Apr 13, 2026
We identified it
Aug 12, 2026
Summary
Aetna is maintaining a non-coverage stance on tumor chemosensitivity assays, classifying them as experimental/investigational/unproven. This policy (CPB 0245, reviewed 2026-04-13) specifies 15+ assay types and their associated CPT codes that will not be covered, including 3D Predict assays, ChemoFx, MiCK apoptosis assay, and others. Billing teams must ensure claims for these assays are not submitted or are denied appropriately, and providers must be aware these services are patient-responsibility.
Action Required
By 2026-04-13: Billing team must update claim denial logic in billing software to systematically deny or flag all claims for CPT codes 0248U, 0249U, 0435U, 0525U, 0511U, 0564T, 81462-81464, 81535-81536, and related tissue culture codes (88230, 88233, 88235, 88237, 88239) when submitted under Aetna plans. Configure system to apply blanket non-coverage status for all chemosensitivity assays listed in CPB 0245 (3D Predict Glioma, 3D Predict Ovarian, ChemoFx, DiSC, Cytoprint, HTCA, MTT, MiCK/CorrectChemo, NexGen, PARIS Test, PredicineATLAS, Reverse Phase Protein Array, and cancer stem cell assays). Notify oncology providers that these assays are not covered by Aetna and patients must be informed of out-of-pocket costs before testing. Update charge capture templates to flag these codes for provider education. Failure to implement will result in claim denials and patient billing disputes.