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Stereotactic Cingulotomy and Capsulotomy (CPB 0288, reviewed 2026-04-16)
Effective date
Not stated in the notice
Identified
Aug 17, 2026
Summary
Aetna covers stereotactic cingulotomy as medically necessary only as a last resort to relieve pain for members with terminal cancer pain. Aetna considers stereotactic cingulotomy experimental, investigational or unproven for chronic intractable non-malignant pain (for example post-stroke pain), drug addiction, intractable seizures and psychiatric diseases. Anterior capsulotomy is considered experimental, investigational or unproven for obsessive compulsive disorder and for all other indications.
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What to do
Action · 4 steps
01Billing team: Bill stereotactic cingulotomy under CPT 61720 or 61735 only for members with terminal cancer pain where the procedure is used as a last resort, and report ICD-10 G89.3 or Z51.5 on the claim, because these codes are covered when the selection criteria are met.
02Do not bill cingulotomy as covered for the experimental indications listed in the policy.
03Anterior capsulotomy has no specific CPT code and is listed as not covered.
04Claims that carry the listed not covered diagnoses, such as F34.1, F95.2, G89.4 or R52, are not covered under this policy.
Codes mentioned
6172061735G89.3Z51.5
Original notice
Stereotactic Cingulotomy and Capsulotomy (CPB 0288, reviewed 2026-04-16)
aetna.com · Always check the source before changing claims.
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