CommercialCoverageHigh impact
Tumor Chemoresistance Assays (CPB 0758, reviewed 2025-12-02)
Aetna·Oncology, Hematology, Pathology·Medical Policy
Effective date
Dec 2, 2025
We identified it
Aug 12, 2026
Summary
Aetna has classified tumor chemoresistance assays (including the Onco4D biodynamic chemotherapy selection assay, CPT 0083U) as experimental, investigational, or unproven, effective immediately. Billing teams must deny all claims for these assays and related chemotherapy drug response testing codes when billed to Aetna plans, as there is insufficient evidence that these tests improve clinical outcomes.
Action Required
IMMEDIATE: Billing team must update denial rules in billing system to automatically deny claims for CPT codes 0083U, 87230, 88104, 88305, 88313, 88358, 89050, 88230, 88233, 88235, 88237, and 88239 when submitted to Aetna plans with ICD-10 diagnosis codes C00.0-D49.9 (neoplasms) or Z51.11-Z51.12 (chemotherapy/immunotherapy encounters). Oncology providers must be notified that Aetna will not cover chemoresistance or chemosensitivity assay testing. Update clinical documentation templates to reflect non-coverage status. Implement pre-billing verification to identify these codes before submission to Aetna. Claims submitted for these services will be denied as experimental/investigational, resulting in patient balance billing and potential reimbursement recapture if already paid.