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AetnaAll Plans · Coverage · Radiology · Radiology, Urology, Oncology +1 moreMedium impact

Transrectal Ultrasound (CPB 0001, reviewed 2026-03-05)

Effective date
Not stated in the notice
Identified
Aug 14, 2026

Summary

Aetna considers transrectal ultrasound (TRUS) medically necessary for specific conditions involving the prostate, rectum and surrounding tissues. These include clinical staging of prostate cancer and rectal carcinoma, determining prostate volume before brachytherapy, evaluation of anal or rectal fistula and peri-rectal abscesses, evaluation of hematospermia, assessment of anal sphincter dysfunction, evaluation of benign or malignant peri-rectal tumors, and infertility or azoospermia where an ejaculatory duct cyst is suspected. Metastatic lesions of unknown source with a PSA greater than 10 ng/ml that could originate in the prostate are also covered. TRUS as a screening test for prostate disease, TRUS elastography for evaluation of prostate cancer, and TRUS for cervical cancer are listed as experimental, investigational or unproven. Last review date is 03/05/2026 and next review is 01/14/2027.

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What to do

Action · 6 steps
01Billing team: Bill CPT 45341, 76872 and 76873 only when the medical necessity criteria in the policy are met for the diagnosis.
02Check benefit plan descriptions before billing infertility services, because some benefit plans exclude infertility coverage.
03Do not bill CPT 76376, 76377, 76856, 76978, 76979, 76981 through 76983 or 78812 for the indications the policy lists as not covered.
04Do not bill TRUS as a screening test, since ICD-10 codes Z12.12 and Z12.5 are listed as not covered.
05Do not bill TRUS for cervical cancer, since ICD-10 codes C53.0 through C53.9 and D06.0 through D06.9 are listed as not covered.
06Check the current version of CPB 0001 at the source link before relying on it, because the policy lists its next review as 01/14/2027.

Codes mentioned

4534176872768737637676377768567697876979769817698378812453425592057155571565834677316773177731876870777617777877789C1738C19C21.8C61C76.3C78.5C79.82D01.1D01.3D07.5D12.7D12.9D29.1D37.5D40.0K60.30K60.529K61.0K61.4K62.89N46.01N46.9R36.1R97.20C53.0C53.9D06.0D06.9Z03.89Z12.12Z12.5

Original notice

Transrectal Ultrasound (CPB 0001, reviewed 2026-03-05)
aetna.com · Always check the source before changing claims.
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Related changes

See all Aetna changes →
Endoscopic Ultrasonography (CPB 0446, reviewed 2026-07-22)MediumNo effective date · Medical PolicyBrachytherapy (CPB 0371, reviewed 2026-05-20)MediumNo effective date · Medical PolicyHigh-Resolution Anoscopy (CPB 0808, reviewed 2026-10-29)MediumNo effective date · Medical PolicyProstate Cancer Screening (CPB 0521, reviewed 2026-08-28)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesRadiologyUrologyOncologyGastroenterologyCode 45341Code 76872Code 76873Code 76376Code 76377Code 76856Code 76978Code 76979Code 76981Code 76983Code 78812Code 45342Code 55920Code 57155Code 57156Code 58346Code 77316Code 77317Code 77318Code 76870Code 77761Code 77778Code 77789Code C1738Code C19Code C21.8Code C61Code C76.3Code C78.5Code C79.82Code D01.1Code D01.3Code D07.5Code D12.7Code D12.9Code D29.1Code D37.5Code D40.0Code K60.30Code K60.529Code K61.0Code K61.4Code K62.89Code N46.01Code N46.9Code R36.1Code R97.20Code C53.0Code C53.9Code D06.0Code D06.9Code Z03.89Code Z12.12Code Z12.5

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