Eye Movement Desensitization and Reprocessing (EMDR) Therapy (CPB 0583, reviewed 2025-09-09)

Effective immediately (2025-09-09): Billing team must update all claim submission and authorization systems to reflect that Aetna covers EMDR therapy ONLY for PTSD (ICD-10 codes F43.10, F43.11, F43.12, Z86.51). All other EMDR claims—regardless of diagnosis—must be flagged as non-covered experimental/investigational services. Action steps: (1) Update billing software edits to deny or require medical review any EMDR claim (CPT 90832-90899) paired with non-PTSD ICD-10 codes; (2) Create system alert for any EMDR with diagnoses including anxiety disorders, chronic pain, autism, mood disorders, eating disorders, cancer-related distress, fibromyalgia, tinnitus, sexual dysfunction, sleep disorders, personality disorders, substance use, or any other condition listed in the policy's experimental section; (3) Notify providers and mental health practices in your network of coverage restriction immediately; (4) Update encounter forms and templates to clarify EMDR is covered for PTSD only; (5) Route any claims for non-PTSD EMDR to medical review for possible patient refund/denial letter; (6) Do NOT submit claims for remote EMDR for post-COVID-related trauma under any circumstances—explicitly non-covered. Failure to enforce this policy will result in claim denials and potential member billing complications.