CommercialCoverageMedium impact
Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)
Aetna·Neurology, Neurosurgery, Oncology +3 more·Medical Policy
Effective date
Mar 26, 2026
We identified it
Aug 14, 2026
Summary
Aetna has updated its Magnetic Resonance Spectroscopy (MRS) policy (CPB 0202, effective 2026-03-26) to clarify covered and non-covered indications. MRS is medically necessary for specific metabolic disorders, leukodystrophies, brain tumors, and hypoxic ischemic encephalopathy, but is considered experimental/investigational for a broad range of other conditions including dementia, epilepsy, psychiatric disorders, and traumatic brain injury. Billing teams must ensure claims are submitted only for the explicitly approved indications to avoid denials.
Action Required
By March 26, 2026: Billing team must update claims submission guidelines and billing system edits to restrict MRS billing (CPT 76390) to ONLY the covered indications listed in policy. For claims with ICD-10 codes NOT on the covered list (e.g., G35.A-G35.D for Multiple Sclerosis, G40.001-G40.919 for Epilepsy, F20.81-F29 for Psychiatric disorders), system should flag for denial or rejection before submission. Do NOT bill CPT codes 0609T, 0610T, 0611T, 0612T under any circumstances—these are explicitly non-covered. Providers and clinical staff must verify diagnosis codes support medical necessity BEFORE ordering MRS. Update prior authorization workflow to require clinical review confirming the indication matches Aetna's covered list. Train billing staff to recognize non-covered indications and communicate denials to providers with reference to specific policy exclusions. Failure to restrict billing to covered indications will result in claim denials and potential overpayment recovery.