CommercialCoverageMedium impact
Stereolithographic Models and Implants (CPB 0613, reviewed 2025-12-03)
Aetna·Cardiothoracic Surgery, Plastic Surgery, Oral & Maxillofacial Surgery +2 more·Surgery
Effective date
Dec 3, 2025
We identified it
Aug 17, 2026
Summary
Aetna (as of 2025-12-03) classifies stereolithographic (3D printed) models and implants as experimental and investigational across multiple surgical applications including cardiac surgery, plastic/reconstructive surgery, penile brachytherapy, cranial implants, and pre-operative anatomic planning. CPT codes 0559T, 0560T, 0561T, and 0562T are NOT covered for these indications. Billing teams must deny or obtain prior authorization denials for these 3D printing codes when billed for excluded surgical applications.
Action Required
Effective immediately (2025-12-03): Billing team must update claim denial logic in billing software to flag and deny CPT codes 0559T, 0560T, 0561T, and 0562T when submitted for cardiac surgery, plastic/reconstructive surgery, penile brachytherapy, cranial implant procedures, or pre-operative anatomic planning. Update claim scrubbing rules to automatically deny these codes for Aetna commercial plans with denial reason: 'Experimental/Investigational - Not Covered.' Providers should be notified via bulletins that these codes are non-covered for the specified indications. Front desk and authorization staff must flag any requests for 3D stereolithographic model creation prior to submission. Failure to implement these denials will result in erroneous claim payments and revenue recovery issues.