CommercialCoverageMedium impact
Optical Coherence Tomography and Microelastography for Solid Tumors and Other Selected Indications (CPB 0886, reviewed 2026-03-03)
Aetna·Oncology, General Surgery, Cardiothoracic Surgery +7 more·Medical Policy
Effective date
Mar 3, 2026
We identified it
Aug 12, 2026
Summary
Aetna has classified intraoperative optical coherence tomography (OCT) and microelastography for solid tumors and multiple surgical indications as experimental, investigational, or unproven. These procedures are NOT covered, including OCT for tumor margin assessment, lymph node evaluation, breast-conserving surgery guidance, and various ophthalmic and surgical applications. Billing teams must deny or reject all claims for these procedures when billed with the specified CPT codes and cancer-related ICD-10 diagnoses.
Action Required
By March 3, 2026: Billing team must update claim submission rules and denial protocols to reject all intraoperative OCT and microelastography claims (CPT codes 0351T, 0352T, 0353T, 0354T, 0470T, 0471T, 76981, 76982, 76983, and related codes) when submitted with Aetna for solid tumor surgeries, breast-conserving procedures, pancreatic lesion differentiation, glaucoma surgery, vitrectomy, laryngeal cancer, prostatectomy, or any indications listed in policy CPB 0886. Configure billing software to automatically deny these claims with reason code indicating experimental/investigational status. Providers should be notified that Aetna will not cover these procedures effective immediately upon policy activation. Claims submitted after March 3, 2026 will be denied; claims submitted before this date with requested effective dates on or after March 3 may also be denied depending on Aetna's interpretation. Ensure prior authorization is NOT requested for these procedures, as they are non-covered experimental services rather than requiring pre-approval.