CommercialCoverageHigh impact
Oral and Esophageal Brush Biopsy (CPB 0686, reviewed 2025-10-15)
Aetna·Dentistry, Dermatology, ENT (Ear, Nose & Throat) +4 more·Medical Policy
Effective date
Oct 15, 2025
We identified it
Aug 12, 2026
Summary
Aetna has classified oral and esophageal brush biopsy procedures (including OralCDx, WATS3D/EndoCDx, and related molecular testing) as experimental, investigational, or unproven, effective immediately. Billing teams must deny or reject all claims for these procedures and related codes when submitted for the listed indications.
Action Required
Effective immediately (2025-10-15): Billing team must update claim submission and adjudication rules in billing software to deny or reject ALL claims for CPT codes 88104, 99000, 40808, 41108, 42800, 42804, 42806, 43191, 43200, 88160 and HCPCS codes D0486, D7287, D7288 when billed with ICD-10 codes C10.0-C10.9, D00.00-D00.08, D10.0-D11.9, D37.01-D37.02, D37.04-D37.09, K09.1-K09.9, K12.0-K13.79, K14.0-K14.9, or Z12.81. Add these codes to the non-covered/experimental procedures list in the system. Providers and billing staff must be notified that oral brush biopsy (OralCDx), esophageal brush biopsy (WATS3D/EndoCDx), DNA-image cytometry, RNA-based brush biopsy, salivary miRNA testing, and esophageal balloon cytologic sampling are not covered under Aetna plans. Update patient encounter forms and provider education materials to reflect non-coverage. Claims submitted for these procedures will be automatically denied; appeals must reference medical policy CPB 0686.