Pediatric Intensive Feeding Programs (CPB 0809, reviewed 2025-12-11)

By December 11, 2025 or immediately upon submission: Billing team must update claim submission protocols to require prior authorization for pediatric intensive feeding program services billed under CPT 92526, 92610, 97530, 97535, 97802, 97803, 97804, 90832, 90838, 90839, 90840, 96156-96171, G0129, G0152, G0153, S9128, S9129, and S9152 when submitted for Aetna members. Claims must include documentation confirming: (1) interdisciplinary team involvement; (2) diagnosis-specific treatment plan with estimated length; (3) failure of single-discipline treatment over 2+ months; (4) one or more qualifying feeding problems (severe food selectivity, enteral dependence, severe psychosocial impairment, or documented malnutrition per NCHS growth charts); (5) medical causes of failure to thrive have been ruled out or treated without resolution. Reject or hold claims lacking this documentation. Flag electrical stimulation claims (not separately coded) as experimental/non-covered. Verify member benefit plan for speech therapy and occupational therapy coverage limitations. Update billing software rules, prior authorization templates, and provider communication materials. Failure to obtain prior authorization and required documentation will result in claim denials.