Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)

By April 14, 2026: Billing team must update claims submission rules in the billing system to enforce Aetna's cerebral perfusion study coverage restrictions. REQUIREMENTS: (1) For CPT 70472 and 70473 (CT perfusion): Require documentation that the study is for acute ischemic stroke, hemorrhagic stroke, subdural hemorrhage, or TIA within first 24 hours. Deny claims for investigational indications (brain death, tumor evaluation, vasospasm, traumatic brain injury, encephalitis, etc.). (2) For cerebral MRI perfusion: Limit coverage to acute cerebral ischemia evaluation only; deny claims for all other indications listed as experimental (glioma evaluation, tumor differentiation, radionecrosis assessment, AVMs, idiopathic normal pressure hydrocephalus, pediatric cerebellar mutism, etc.). (3) Implement system rule: Flag and deny claims submitting BOTH CT perfusion (70472/70473) AND MRI perfusion for the same patient episode as not medically necessary. (4) Update prior authorization templates to reflect these coverage boundaries. (5) Notify neurology, neurosurgery, and radiology departments of the coverage restrictions—particularly that perfusion studies for tumor assessment, brain death confirmation, and traumatic brain injury are no longer covered. Failure to implement these restrictions will result in claim denials and potential audit exposure for inappropriate billing.