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AetnaCommercial · Coverage · Medical Policy · Neurology, NeurosurgeryMedium impact

Parkinson's Disease (CPB 0307, reviewed 2026-02-24)

Effective date
Not stated in the notice
Identified
Aug 13, 2026

Summary

Aetna's Parkinson's disease clinical policy bulletin (CPB 0307, reviewed February 24, 2026) considers carbidopa and levodopa enteral suspension (Duopa) medically necessary for treating motor fluctuations in advanced Parkinson's disease when the listed criteria are met, and considers it experimental, investigational, or unproven for all other indications. Neuropsychological testing (CPT 96132, 96133, 96146) is covered when selection criteria are met, and SPECT scanning (CPT 78607, HCPCS A9584) is covered when selection criteria are met to distinguish Parkinson's disease from essential tremor. The policy also sets criteria for pallidotomy and lists diagnostic tests, non-surgical treatments and surgical procedures it considers experimental, investigational, or unproven.

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What to do

Action · 10 steps
01Billing team: For Duopa, confirm it is prescribed by or in consultation with a neurologist or a specialist in treating Parkinson's disease.
02For initial approval, confirm the member is levodopa responsive with clearly defined on periods, has off periods of at least 3 hours per day despite optimization efforts, and has had an inadequate response or intolerable adverse event with oral carbidopa-levodopa plus a COMT inhibitor, a dopamine agonist, or a MAO-B inhibitor.
03For continued Duopa therapy, the member must have a positive clinical response to Duopa.
04The CADD-Legacy 1400 portable infusion pump is considered medically necessary durable medical equipment for members who meet the Duopa criteria.
05For foscarbidopa/foslevodopa (Vyalev) injection, refer to the pharmacy benefit plan.
06For pallidotomy, confirm the member has idiopathic PD, has tried and failed medical therapy, exhibits 2 of 4 major symptoms (bradykinesia, tremor, rigidity, gait disturbance), has a history of positive response to dopaminergic replacement therapy, and has been screened by a neurologist with expertise in movement disorders.
07Pallidotomy is of no proven value in members with Parkinson-plus or atypical Parkinson's disorders, severe dementia or cerebral atrophy, or Hoehn and Yahr Stage V.
08Bill neuropsychological testing codes 96132, 96133 and 96146 only when selection criteria are met.
09Do not bill SPECT (78607) for distinguishing PD from other parkinsonian syndromes or for monitoring progression, because the policy considers it experimental for those uses.
10Do not bill MRI codes 70551 to 70553 for differentiating PD from other parkinsonian syndromes, because the policy lists them as not covered for that purpose.

Codes mentioned

96132961339614678607A9584J7340E0779E0780E0781617206173561863618646186761868G20.A1G21.0G21.9G23.1G31.85

Original notice

Parkinson's Disease (CPB 0307, reviewed 2026-02-24)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesNeurologyNeurosurgeryCode 96132Code 96133Code 96146Code 78607Code A9584Code J7340Code E0779Code E0780Code E0781Code 61720Code 61735Code 61863Code 61864Code 61867Code 61868Code G20.A1Code G21.0Code G21.9Code G23.1Code G31.85

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