Back to dashboard
CommercialCoverageMedium impact

Huntington's Disease (CPB 0614, reviewed 2026-02-25)

Aetna·Neurology, Neurosurgery, Psychiatry +1 more·Medical Policy
Effective date
Feb 25, 2026
We identified it
Aug 15, 2026
Days to comply

Summary

Aetna has updated its Huntington's Disease clinical policy (CPB 0614, effective 2026-02-25) to designate numerous diagnostic tests, biomarkers, and treatment interventions as experimental, investigational, or unproven. This policy classifies over 40 specific treatments and diagnostic approaches—including gene therapy, stem cell transplantation, deep brain stimulation, various biomarker measurements, and neuroimaging modalities—as non-covered services. Billing teams must immediately deny or require prior authorization for claims using the listed CPT/HCPCS codes when billed for Huntington's disease indications.

Action Required

Action needed
By March 15, 2026: Billing team must update claim adjudication system to flag all claims containing the listed CPT codes (0232T, 0310T, 38230-38243, 61720, 61798-61799, 61863-61864, 61867-61868, 61880, 61885-61886, 64550, 64885-64886, 70553-70554, 76390, 78608-78609, 78813-78814, 78816, 81401, 81405, 83520, 83529, 90867-90870, 95836, 95970-95971, 95974, 95976-95977, 95983-95984, 38225) when linked to Huntington's disease diagnosis codes (ICD-10: G10 and related codes). Configure system to automatically deny these claims or route to prior authorization department with notation 'Experimental/Investigational per CPB 0614.' Immediately communicate to all providers and clinical staff that these interventions are non-covered for Huntington's disease treatment. Update billing software rules and encounter templates. Failure to enforce this policy will result in claim denials post-adjudication and potential payment clawbacks from Aetna for improperly processed claims. No grace period applies—policy is effective immediately upon date specified.

Affected Billing Codes

38230
38232
38240
38241
38242
38243
61720
61798
61799
61863
61864
61867
61868
61880
61885
61886
64550
64885
64886
70553
70554
76390
78608
78609
78813
78814
78816
81401
81405
83520
83529
90867
90868
90869
90870
95836
95970
95971
95974
95976
95977
95983
95984
38225