Median Arcuate Ligament Syndrome: Treatment (CPB 1092, reviewed 12-2026-01)

Immediately: Billing team must implement Aetna MALS treatment policy (CPB 1092) requirements in claims review and prior authorization processes. (1) Update billing system to require prior authorization for CPT 35631, 35632, 37236, 37237, and 64530 when billed for MALS treatment. (2) For surgical decompression claims (CPT 35631/35632): Require documentation showing ALL four criteria met—symptomatic postprandial abdominal pain, duplex ultrasound with celiac artery velocity >200 cm/sec, cross-sectional imaging (CT/MRI) showing stenosis, CTA/MRA confirming hooked/J-shaped appearance, AND documented preoperative psychiatric/behavioral assessment. (3) For percutaneous revascularization (CPT 37236/37237): Require documentation of failed prior surgical decompression, refractory postprandial pain, exclusion of mast cell activation syndrome and functional GI disorders, and imaging confirmation of persistent stenosis (>200 cm/sec on duplex or >30% residual stenosis on CTA/MRA). (4) For celiac plexus nerve blocks (CPT 64530): Accept claims either for diagnostic purposes with prior imaging studies documented OR for treatment with confirmed MALS diagnosis. (5) Deny all claims for gastric tonometry as experimental/investigational—no CPT code coverage exists for this modality. (6) Do NOT separately reimburse robotic assistance for surgical decompression; integrate into primary procedure fee. (7) Verify all supporting imaging codes (74174, 74175, 74185, 93975, 93976) are billed with appropriate medical necessity. (8) Flag and deny claims with ICD-10 diagnoses of mast cell activation syndrome (D89.40-D89.49) or functional GI disorders (K59.0-K59.9, K30) when submitted as alternative diagnoses for MALS revascularization. Failure to implement will result in claim denials and potential overpayment recovery.