Spinal Ultrasound (CPB 0628, reviewed 2025-12-11)

Immediately (effective 2025-12-11): Billing team must implement the following: (1) Update billing system edits to DENY CPT 76800 (Ultrasound, spinal canal and contents) for all patients age >18 months (or establish newborn/infant age parameters based on claims data). (2) Flag all existing claims for adult spinal ultrasound for reconsideration/denial. (3) Instruct providers and front desk staff that CPT 76800 is covered ONLY for newborns and infants with documented ICD-10 codes matching the covered list (Q05.0–Q05.9, Q06.0–Q06.9, Q07.01–Q07.03, Q42.2, Q42.3, Q76.49, P10.0–P10.3, P10.8–P10.9, P11.5, P52.0–P52.22, P52.3, P52.5, G96.00–G96.09, G97.51, G97.61, G97.63). (4) Deny or require redirection to MRI/CT for adult indications including scoliosis evaluation, spinal muscular atrophy, epidural abscess, and neuraxial block guidance (except intraoperative use). (5) Update encounter forms and clinical decision support to reflect that adult spinal ultrasound is experimental/investigational. (6) Do NOT bill CPT 76800 in conjunction with epidural injection codes (62320–62327, 64400–64530) unless the ultrasound is intraoperative in a newborn/infant. Claims submitted in violation of this policy will be denied; failure to update systems will result in significant claim rejections and potential Aetna recoupment.