CommercialCoverageHigh impact
Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2025-08-22)
Aetna·Orthopedics, Rheumatology, Endocrinology +3 more·Medical Policy
Effective date
Aug 22, 2025
We identified it
Aug 12, 2026
Summary
Aetna has designated biochemical markers of bone remodeling as experimental, investigational, or unproven for all listed indications, including osteoporosis screening/diagnosis, fracture risk evaluation, and aseptic loosening monitoring. Billing teams must deny claims for these tests when billed for the non-covered indications specified in this policy, effective immediately.
Action Required
Effective immediately (August 22, 2025): Billing team must implement hard stops in claims processing system to deny or require manual review for the following CPT codes (82523, 82607, 82608, 83090, 83500, 83505, 83529, 83937, 84075, 84080, 88319) when billed with ICD-10 codes F32.0-F33.9, M14.671-M14.679, M80.00XA-M81.8, M87.08, N18.1-N18.9, N25.0, Q78.0, T84.030A-T84.039S, T84.050A-T84.058S, or Z13.820. Update billing software rules and prior authorization workflows to reflect non-coverage. Providers and front desk must be notified that bone turnover marker tests cannot be billed for osteoporosis screening, diagnosis, management, CKD evaluation, osteonecrosis risk assessment, or joint arthroplasty complication monitoring. Claims submitted for these indications will be denied. Develop denial message templates and retrain billing staff on proper code/diagnosis pairing per this policy.