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AetnaAll Plans · Coverage · Surgery · Psychiatry, NeurologyMedium impact

Naltrexone Implants (CPB 0878, reviewed 2025-12-22)

Effective date
Not stated in the notice
Identified
Aug 16, 2026

Summary

Aetna considers naltrexone implants experimental, investigational, or unproven for alcohol addiction, amphetamine use, autism spectrum disorders, buprenorphine dependence, fentanyl-induced respiratory depression, impulse control disorders in Parkinson disease, narcotic addiction, prolactinoma (prolactin-secreting pituitary tumor), and trichotillomania, because of insufficient evidence in the peer-reviewed published medical literature and because their safety and effectiveness have not been established. The policy does not apply to Vivitrol injections or other commercially available naltrexone formulations that are not implants. Naltrexone implants have no specific HCPCS code, and the not-covered ICD-10 codes include alcohol dependence (F10.20 to F10.29), opioid use disorder codes (F11), stimulant abuse (F15), pervasive developmental disorders (F84.0 to F84.9), Parkinson disease impulse control disorder (G20.A1 to G21.9), and benign pituitary neoplasm (D35.2).

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What to do

Action · 3 steps
01Billing team: Naltrexone implants are not covered for alcohol addiction, amphetamine use, autism spectrum disorders, buprenorphine dependence, fentanyl-induced respiratory depression, impulse control disorders in Parkinson disease, narcotic addiction, prolactinoma, or trichotillomania, because the policy considers these experimental, investigational, or unproven.
02The not-covered ICD-10 codes listed in the policy include D35.2 (benign neoplasm of pituitary gland) and F63.3 (trichotillomania).
03Vivitrol injections (J2315) and other naltrexone formulations that are not implants are outside this policy.

Codes mentioned

D35.2F63.3

Original notice

Naltrexone Implants (CPB 0878, reviewed 2025-12-22)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesPsychiatryNeurologyCode D35.2Code F63.3

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