All PlansCoverageMedium impact
Evoked Potential Studies (CPB 0181, reviewed 2026-04-21)
Aetna·Neurology, Neurosurgery, Audiology +2 more·Medical Policy
Effective date
Apr 21, 2026
We identified it
Aug 14, 2026
Summary
Aetna has updated its Evoked Potential Studies policy (CPB 0181, effective 2026-04-21) clarifying medical necessity criteria for somatosensory evoked potentials (SEPs), visual evoked potentials (VEPs), brainstem auditory evoked response (BAER), and cervical vestibular evoked myogenic potential (cVEMP). The policy establishes specific approved indications for coverage while designating numerous other uses as experimental/investigational. Billing teams must ensure claims align with the narrow list of covered indications or face denial.
Action Required
By 2026-04-21: Billing and coding teams must review all evoked potential study claims submitted to Aetna and cross-reference against the specific medical necessity indications listed in CPB 0181. Update claim submission procedures to: (1) require provider documentation confirming the claim meets one of Aetna's approved indications (spinal cord injury assessment, anoxic encephalopathy, brain death evaluation, multiple sclerosis diagnosis, CNS deficit localization, spinocerebellar degeneration management, unexplained myelopathy, or myoclonus differentiation for SEPs/DSEPs; MS diagnosis/monitoring, visual loss evaluation in non-communicative patients, CDMS risk assessment, or visual field defect localization for VEPs; brain death/coma assessment, brainstem recovery monitoring, demyelinating disease diagnosis, post-meningitic deafness, acoustic neuroma diagnosis, pediatric hearing loss evaluation, CNS deficit localization, or infant/child hearing loss screening for BAER; or SCDS evaluation with inconclusive prior testing or post-cochlear implant bilateral sensorineural hearing loss for cVEMP); (2) deny or request additional documentation for claims listing indications outside these categories, as they are classified experimental/investigational; (3) train front-desk and coding staff on these limits. Providers should be notified that claims lacking proper medical necessity documentation will be denied. Update internal billing software rules to flag evoked potential claims for compliance review.