CommercialCoverageHigh impact
Salivary Tests (CPB 0608, reviewed 2025-10-01)
Aetna·Endocrinology, Internal Medicine, Family Medicine +6 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Aug 16, 2026
Summary
Aetna's updated Salivary Tests policy (CPB 0608, effective 2025-10-01) clarifies coverage for salivary cortisol testing, which is NOW medically necessary ONLY for diagnosing Cushing's syndrome using CPT 82530 or 82533. Nearly all other salivary tests—including cortisol for adrenal insufficiency, depression, bipolar disorder, menopause screening, and numerous cancer/biomarker tests—are classified as experimental and NOT covered. Billing teams must immediately reject or deny claims for non-Cushing's syndrome salivary cortisol and all other listed experimental salivary tests.
Action Required
By October 1, 2025: Billing team must immediately implement the following: (1) CPT 82530 and 82533 are COVERED ONLY when diagnosis is E24.0-E24.9 (Cushing's syndrome); deny all other diagnoses. (2) ALL other salivary tests listed in the policy—including CPT 0011U, 0296U, 0462U, 82626, 82627, 82670-82679, 83516, 83520, 83529, 83615, 83937, 84144, 84402-84403, 84436-84439, 84443, 84479-84481, 86316, 88341-88344, and HCPCS S3650—are NOT covered (experimental/investigational). (3) Update billing system edits to block claims for salivary cortisol with diagnoses E27.0-E27.9 (adrenal insufficiency), F30-F34 (mood disorders), N95 (menopause), and all cancer/oral diagnoses (C00-C10.9, etc.). (4) Add denial language referencing CPB 0608 for all rejected salivary test claims. (5) Providers must verify Cushing's syndrome diagnosis BEFORE ordering salivary cortisol; coordinate with clinical teams to educate on coverage restrictions. Claims submitted after October 1, 2025 without Cushing's syndrome diagnosis will be denied. No prior authorization is required for covered Cushing's testing, but medical necessity (diagnosis code E24.0-E24.9) is mandatory.