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Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (CPB 0788, reviewed 2025-11-19)

Aetna·Neurology, Neurosurgery, Geriatrics +3 more·Medical Policy
Effective date
Nov 19, 2025
We identified it
Aug 12, 2026
Days to comply

Summary

Aetna has updated its clinical policy bulletin (CPB 0788) to clarify that 70+ treatments for Alzheimer's disease remain experimental, investigational, or unproven and are not covered. The policy provides a comprehensive list of non-covered procedures and their associated billing codes, including deep brain stimulation, stem cell therapy, various immunotherapies, and pharmacological interventions. Billing teams must ensure claims for these treatments are denied or require prior authorization review based on patient coverage terms.

Action Required

Action needed
Immediately: Billing team must update system denial rules and prior authorization workflows to reflect that CPT codes 0780T, 36514, 36516, 38240, 38241, 38242, 44705, 61863-61868, 61880, 61885, 62160, 62180-62258, 63740-63746, 64553, 90281-90283, 95836, 95976-95977, 95983-95984, 97810-97814, 98960, 99183, and HCPCS codes A4575, A4633, C1767, C1778, C1816, E0203, E0446, G0176 are NOT COVERED for Alzheimer's disease treatment when submitted by Aetna members. Before processing any claims with these codes for Alzheimer's disease diagnosis (ICD-10 G30.x series), flag for medical necessity review or automatic denial per policy. Update claim scrubbing logic to cross-reference ICD-10 diagnosis codes against this treatment list. Notify providers in neurology, neurosurgery, and geriatrics specialties of non-coverage. Document policy reference CPB 0788 (reviewed 2025-11-19) in all denial communications. Failure to implement will result in improper reimbursement and potential claim recovery actions by Aetna.

Affected Billing Codes

36514
36516
38240
38241
38242
44705
61863
61864
61867
61868
61880
61885
62160
62180
62181
62182
62190
62192
62200
62223
62225
62230
62240
62258
63740
63741
63742
63743
63744
63745
63746
64553
90281
90282
90283
95836
95976
95977
95983
95984
97810
97811
97812
97813
97814
98960
99183
A4575
A4633
C1767
C1778
C1816
E0203
E0446
G0176
Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (CPB 0788, reviewed 2025-11-19) | Aetna | PolicyChanges.app