Medicare AdvantageCoverageHigh impact
Selected Kidney Function Tests (CPB 0775, reviewed 2026-07-31)
Aetna·Nephrology, Endocrinology, Internal Medicine +2 more·Medical Policy
Effective date
Jul 31, 2026
We identified it
Aug 16, 2026
Summary
Aetna has updated its medical policy on selected kidney function tests (CPB 0775) to designate multiple advanced kidney function and genetic tests as experimental, investigational, or unproven. Specific CPT codes including 0105U, 0407U, 0602T, 0603T, 0259U, 0355U, 0384U, 0385U, 0628U, and 0653U are now non-covered for their listed indications. Billing teams must immediately stop billing these codes to Aetna and implement claims denials protocols.
Action Required
By July 31, 2026: Billing team must update all billing software and claim submission systems to mark the following codes as non-covered for Aetna claims: 0105U, 0407U, 0602T, 0603T, 0259U, 0355U, 0384U, 0385U, 0628U, and 0653U. Configure system to automatically deny or route for manual review any claims containing these codes submitted to Aetna with the ICD-10 indications listed in the policy (CKD codes N18.1-N18.9, N19, N17.0; diabetes codes E11.00-E11.9, E08.00-E13.9; and other listed conditions). Notify all clinical staff and providers in nephrology, endocrinology, and primary care of the non-covered status. Update patient financial counseling materials to reflect these tests require out-of-pocket payment or alternative coverage verification. Implement denial management process to track rejected claims and identify patients who may need notification of non-coverage.