Toxicology: Per- and Polyfluoroalkyl Substances (PFAS) Testing (CPB 1067, reviewed 2026-01-14)

Effective immediately (2026-01-14): Billing team must implement claim rejection protocols for all PFAS testing claims submitted to Aetna. (1) Update billing software denial rules to automatically flag CPT codes 0394U, 0457U, 0535U, 0589U, and 82542 when paired with ICD-10 codes T65.91XA-T65.91XS, Z13.88, or Z77.010-Z77.098. (2) Do not submit claims for PFAS testing under these code combinations to Aetna; instead, inform patients and providers that Aetna classifies PFAS testing as experimental/unproven and will not reimburse. (3) Update encounter forms and EHR templates to alert providers before ordering PFAS tests that Aetna will not cover. (4) Train front desk and billing staff to inform patients during registration that PFAS testing is not covered by Aetna and patient will be responsible for out-of-pocket costs. (5) If claims are submitted in error, expect denials with reason code indicating non-covered experimental service. Contact Aetna appeals only if new clinical evidence of medical necessity emerges.