Smell and Taste Disorders: Diagnosis (CPB 0390, reviewed 2026-05-26)

By June 26, 2026: Billing team must implement the following controls in Aetna claim submission workflows: (1) Limit reimbursement to ONE initial visit plus ONE follow-up visit for smell/taste disorder testing per member per condition—flag claims exceeding this threshold for denial; (2) Block/deny claims for experimental procedures including electrogustometry (no specific CPT code), genotyping of TAS2R38 gene (no specific CPT code), cerebrospinal fluid SARS-CoV-2 antibody testing, magnetic resonance imaging for COVID-19 olfactory dysfunction (CPT 70540, 70542, 70543), PET scan brain (CPT 78608), SPECT imaging, rhinomanometry (CPT 92512), rhinometry/acoustic rhinometry (CPT 92512), nitric oxide testing (CPT 95012), Helicobacter pylori testing (CPT 78267, 78268, 83013, 83014, 87338); (3) Update billing system to require diagnosis codes R43.0-R43.9 for covered procedures, and deny/alert on diagnosis codes G52.0 and U09.9 when paired with experimental tests; (4) Ensure providers and front-desk staff are informed of the visit limit restriction and experimental procedure list to prevent incorrect billing submissions. Failure to implement will result in claim denials and potential overpayment recoupture.