Extended-Release Buprenorphine Injectables (CPB 0910, reviewed 2025-12-30)

By January 15, 2026: Billing team must implement the following changes to align with Aetna's updated extended-release buprenorphine policy: (1) Update billing system to require documentation that Sublocade patients have been stabilized on transmucosal buprenorphine for a minimum of 7 days AND are enrolled in a complete treatment program including drug testing, counseling, and psychosocial support before approving claims for J0577, J0578, Q9991, and Q9992; (2) Configure system to automatically route claims for Brixadi (J0577, J0578) for coverage determination based on patient's current buprenorphine treatment status; (3) Ensure all claims for extended-release buprenorphine injectables include corresponding ICD-10 codes from F11.10-F11.99 range to establish medical necessity; (4) Train billing staff that all other indications beyond the specified coverage criteria should be flagged as experimental/investigational and will require prior authorization or will be denied; (5) Update claim denial templates to clearly communicate coverage restrictions to providers; (6) Implement validation checks to ensure supporting clinical documentation (treatment program enrollment, stabilization period, drug testing results) is attached before claim submission. Failure to implement these requirements will result in claim denials and potential compliance issues with Aetna.