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CommercialCoverageHigh impact

Pulsed Radiofrequency (CPB 0735, reviewed 2025-10-29)

Aetna·Pain Management, Neurology, Neurosurgery +4 more·Medical Policy
Effective date
Oct 29, 2025
We identified it
Aug 15, 2026
Days to comply

Summary

Aetna has classified pulsed radiofrequency (PRF) as experimental, investigational, or unproven for ALL indications, effective immediately. This is a comprehensive non-coverage determination affecting 70+ clinical conditions and specific device/combination therapies. Billing teams must deny or reject all PRF claims submitted under Aetna plans, regardless of diagnosis code or clinical justification, as no specific CPT codes exist for PRF procedures.

Action Required

Action needed
Immediately effective October 29, 2025: (1) Billing team must implement system-wide block on all pulsed radiofrequency claims submitted to Aetna plans. (2) Update billing software to flag/deny any encounter forms or claims containing ICD-10 codes listed in this policy (B02.21-B02.29, D21.0-D21.9, E08.40-E13.49, F52.4, G43.701-G43.719, G44.1, G50.0, G52.1, G56.00-G56.03, G57.00-G57.93, G58.0, G58.8-G58.9, G60.3, G60.8-G60.9, G81.00-G81.94, G89.21-G89.28, G89.3, G90.01-G90.09, G90.50-G90.59, H93.11-H93.19, I47.0, I47.20-I47.29, I49.01, I69.398, K03.3, L74.510-L74.9, L90.6, M12.9, M17.0-M17.9, M25.50-M25.579, M51.15-M51.17, M51.26, M51.9, M53.3, M54.10, M54.12, M54.17-M54.18, M54.2, M54.50-M54.59, M54.6, M54.81, M54.89-M54.9, M72.2, M75.00-M75.02, M77.40-M77.42, M79.10-M79.18, M79.2, M79.601-M79.676, N50.811-N50.819, N94.2, N94.810-N94.819, R10.2, R39.11, R39.15, R51.0-R51.9, R52, Z89.011-Z89.9) when Aetna is the primary payer. (3) Providers and clinical staff must communicate to patients that pulsed radiofrequency procedures are not covered by Aetna and obtain signed waiver/attestation forms before proceeding with any PRF treatment. (4) Do NOT submit claims for Stimpod NMS460 nerve stimulator devices or combined ganglion impar block + PRF or combined platelet-rich plasma to Gasserian ganglion + PRF procedures to Aetna. (5) Update patient eligibility verification and financial counseling templates to reference PRF non-coverage. Failure to implement this block will result in claims being denied post-service with recoupment liability falling to the practice.