CommercialCoverageHigh impact
Ultrasound Guidance – Selected Indications (CPB 0952, reviewed 2026-04-27)
Aetna·Radiology, Anesthesiology, Orthopedics +7 more·Radiology
Effective date
Apr 27, 2026
We identified it
Aug 14, 2026
Summary
Aetna has updated CPB 0952 to comprehensively define ultrasound-guided procedures that are medically necessary versus those considered experimental/unproven. This policy establishes a definitive list of 80+ covered ultrasound-guided procedures (requiring medical necessity documentation) and 100+ non-covered procedures. Billing teams must verify ultrasound guidance appropriateness before claim submission to avoid denials for procedures on the experimental/unproven list.
Action Required
By 2026-04-27: Billing team must implement pre-claim review process for all ultrasound-guided procedures billed to Aetna. (1) Create internal reference document listing 80+ covered procedures from CPB 0952 medically necessary section and 100+ non-covered procedures from experimental section. (2) Update billing software/EMR to flag claims with ultrasound guidance modifier to trigger manual verification against policy lists before submission. (3) Train billing staff and providers on the distinction—covered procedures require medical necessity documentation; procedures on the experimental list will be denied if billed with ultrasound guidance. (4) For procedures listed as covered only after failed unguided attempt (e.g., Baker's cyst, carpal tunnel injection, posterior GH joint injection), require documentation of prior unsuccessful unguided attempt in medical record. (5) Audit high-volume ultrasound-guided procedures in your practice (e.g., nerve blocks, joint injections, biopsies) against both policy lists. Consequence: Claims for non-covered procedures with ultrasound guidance will be denied; claims lacking required documentation of failed unguided attempts will be denied. Contact Aetna for clarification on any procedures not explicitly listed.