AetnaAll Plans · Coverage · Pharmacy · Endocrinology, ENT (Ear, Nose & Throat), Gastroenterology +2 moreMedium impact
Ethanol Injection for Thyroid Lesions and Other Selected Indications (CPB 0395, reviewed 2026-07-06)
Effective date
Not stated in the notice
Identified
Aug 14, 2026
Summary
Ethanol sclerotherapy of thyroglossal duct cysts is medically necessary only when a monocystic lesion is present, cystographic studies show no extravasation, and cytology shows the lesion is benign. Ethanol sclerotherapy is also medically necessary for symptomatic venous malformations of the head and neck, absolute ethanol injection is medically necessary for overt upper gastrointestinal bleeding, and ethanol ablation is medically necessary for benign thyroid nodules. Ethanol sclerotherapy for endometrioma, intradiscal radiopaque gelified ethanol injection for lumbar disc herniation, percutaneous ethanol injection for thyroid cancer, and ultrasound-guided ethanol sclerotherapy for Warthin's tumor are considered experimental, investigational, or unproven.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
01Claims for ethanol sclerotherapy of thyroglossal duct cysts need documentation that a monocystic lesion is present, that cystographic studies show no extravasation, and that cytology shows the lesion is benign.
02Repeat injections after 1 month may be medically necessary if the cyst recurs.
03Ethanol sclerotherapy of thyroglossal duct cysts is considered experimental, investigational, or unproven when these criteria are not met.
04The covered diagnosis codes for these indications include D34, K29.71, K92.2 and Q89.2, and the covered procedure codes include CPT 43236 and 49185.
Summaries are AI-assisted. Always confirm against the original payer notice.
What is PolicyChanges
One workspace for payer rules, prior auth, coding and compliance
Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.