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Rheumatic Diseases: Selected Tests (CPB 0866, reviewed 2025-12-22)
Aetna·Rheumatology, Internal Medicine, Pathology +1 more·Medical Policy
Effective date
Dec 22, 2025
We identified it
Aug 16, 2026
Summary
Aetna's updated Rheumatic Diseases policy (CPB 0866, effective 2025-12-22) clarifies coverage for specific rheumatologic tests. Anti-CCP antibodies (CPT 86200) remain covered for rheumatoid arthritis diagnosis, HLA-B27 testing is covered for ankylosing spondylitis and Reiter's syndrome, myositis antibody panels are covered for inflammatory myopathy, anti-dsDNA antibodies are covered for SLE evaluation, and UBA1 mutation testing (CPT 0500U) is newly covered for VEXAS syndrome detection. However, numerous investigational tests including Avise panels, aiSLE DX, PrismRA, and other biomarker panels are now explicitly listed as non-covered (experimental/investigational).
Action Required
By 2025-12-22: Billing team must immediately update claims processing system to distinguish between COVERED and NON-COVERED rheumatologic tests per this policy. COVERED tests requiring no prior auth: CPT 86200 (Anti-CCP for RA only), CPT 81374/86812 (HLA-B27 for ankylosing spondylitis/Reiter's only), CPT 83516 (Myositis antibody panel for inflammatory myopathy only), CPT 0039U (anti-dsDNA for SLE only), CPT 0500U (UBA1 for VEXAS syndrome only). NON-COVERED/INVESTIGATIONAL tests requiring claim denials: CPT 0446U, 0447U (aiSLE DX), CPT 81490 (RA 12-biomarker panel), CPT 83520 (MCV antibodies), CPT 0456U (PrismRA), CPT 0521U (Seronegative RA Panel), CPT 0062U, 0312U (Avise SLE panels), and all other tests listed in experimental section. Update billing software with denial logic for non-covered codes. Providers must only order covered tests for specific indicated diagnoses per ICD-10 coding requirements listed in policy. Claims submitted for experimental tests will be denied by Aetna without exception. Front desk and EMR staff should flag orders for these tests before submission.