CommercialCoverageHigh impact
Ablative Procedures for Prostate Cancer (CPB 0843, reviewed 2026-02-25)
Aetna·Urology, Oncology, Radiation Oncology·Medical Policy
Effective date
Feb 25, 2026
We identified it
Aug 12, 2026
Summary
Aetna's updated Clinical Policy Bulletin 0843 (effective 2026-02-25) designates multiple ablative procedures for prostate cancer as experimental, investigational, or unproven and therefore non-covered. This includes MRI-guided focal laser ablation, dual-fiber laser ablation, water vapor thermotherapy, magnetic field induction ablation, transperineal focal laser ablation, and metastasis-directed therapy. Billing teams must deny claims for these procedures and associated CPT codes when submitted for Aetna members.
Action Required
By 2026-02-25: Billing team must update billing system to automatically deny or flag claims containing CPT codes 0582T, 0655T, 0738T, 0739T, 0941T, 0942T, 0943T, 51721, 53854, 55877, 55881, 55882, 96570, 96571, and HCPCS code C9734 when submitted to Aetna with ICD-10 diagnosis codes C61, N39.0-N39.9, R32, or Z19.2. Update claim denial templates to reference CPB 0843 and classify these procedures as non-covered experimental/investigational services. Notify urology providers of non-coverage effective date. Route any appeals to medical necessity review per Aetna's standard process, though coverage is unlikely given experimental designation. Claims submitted on or after this date without prior denial protocol in place will face processing delays and patient balance issues.