CommercialCoverageMedium impact
Selective Peripheral Denervation (Bertrand Procedure) (CPB 0401, reviewed 2026-07-06)
Aetna·Neurology, Neurosurgery, PM&R (Physical Medicine & Rehab)·Medical Policy
Effective date
Jul 6, 2026
We identified it
Aug 16, 2026
Summary
Aetna has issued a new medical policy (CPB 0401, effective 2026-07-06) establishing coverage criteria for Selective Peripheral Denervation (Bertrand Procedure) for severe spasmodic torticollis (cervical dystonia). The procedure is medically necessary only when patients have disabling symptoms AND have failed 3+ months of oral anticholinergics/benzodiazepines OR botulinum toxin therapy, or experienced medication adverse effects/botox resistance. Combined SPD with deep brain stimulation and selective peripheral neurectomy for upper limb spasticity remain experimental/investigational.
Action Required
By 2026-07-06, billing team must implement the following: (1) Update billing system to require prior authorization for CPT 64616 and 64640 when billed with ICD-10 G24.3 (spasmodic torticollis). (2) Configure system to deny claims for selective peripheral denervation procedures without documented evidence of: disabling symptoms AND either 3+ months of failed oral anticholinergic/benzodiazepine therapy OR 3+ months of failed botulinum toxin therapy (CPT 64616 or HCPCS J0585/J0586/J0587/J0588) OR documented adverse effects/resistance to these medications. (3) Ensure ICD-10 G80.1 (spastic diplegial cerebral palsy/upper limb spasticity) claims for selective peripheral denervation are flagged as non-covered and denied. (4) Do NOT cover combined SPD + deep brain stimulation procedures; configure system to deny these claims. (5) Add prior authorization requirement to encounter forms for neurology/neurosurgery providers performing these procedures. (6) Train billing staff on medical necessity documentation requirements. Failure to implement these edits will result in claim denials for non-compliant cases.