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Eagle's and Ernest Syndrome (CPB 0400, reviewed 2026-06-30)
Effective date
Not stated in the notice
Identified
Aug 14, 2026
Summary
Aetna's Clinical Policy Bulletin 0400 considers styloidectomy medically necessary for Eagle's syndrome only when specific criteria are met, with separate criteria for the non-vascular form and the vascular form linked to carotid artery dissection. Radiofrequency thermoneurolysis is considered experimental, investigational or unproven for Eagle's and Ernest syndromes, and styloidectomy for jugular vein stenosis, for carotid stenosis without dissection, and for other listed indications such as tinnitus, headache and neck pain is also considered experimental, investigational or unproven.
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What to do
Action · 4 steps
01Claims for styloidectomy for Eagle's syndrome need documentation of all of the following: at least 3 of these symptoms (pharyngeal pain with hemifacial radiation, otalgia, odynophagia, sensation of foreign body in the pharynx, discomfort with neck rotation, increased salivation, dizziness); an in-person exam documenting pain with palpation of the styloid process in the tonsillar fossa; a formal imaging report showing an elongated styloid process of at least 30mm; and documentation that other causes, including temporomandibular syndrome and dental problems, were ruled out.
02Claims also need at least 6 months of conservative management after the confirmed diagnosis, including at least one anticonvulsant or antidepressant taken for at least 3 months plus at least one of: a trial of oral steroids or NSAIDs, local steroid/anesthetic injections, or physical therapy, and an in-person follow-up visit documenting results of treatment, continued qualifying symptoms and continued pain on palpation of the styloid process.
03For vascular Eagle's syndrome, claims need carotid artery dissection confirmed by CT angiography or conventional angiography, anticoagulation therapy started, and a formal imaging report showing an elongated styloid process of at least 30mm at the level of the dissection.
04Radiofrequency thermoneurolysis is not covered for the indications listed in the policy.
Codes mentioned
3622136222362233622436227362286460070250702607035570450704607047070486704877048870498C9144J0665J0666J0670J0702J1010J1094J1100J1130J1165J1320J1700J1710J1720J1738J1741J1953J2002J2003J2004J2401J2402J2560J2795J2919J3299J3300J3301J3302J3303J3304J7509J7510J7512J8540J8541Q2009S0078H92.01H92.09I65.21I65.29K11.7M54.2M89.8X8R07.0R09.A2R13.19R42Z79.01G93.2H93.A1H93.A9H93.11H93.19K00.0K08.9M26.601M26.69R41.89R51.9R53.82
Original notice
Eagle's and Ernest Syndrome (CPB 0400, reviewed 2026-06-30)
aetna.com · Always check the source before changing claims.
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