CommercialCoverageHigh impact
Stereotactic Radiosurgery (CPB 0083, reviewed 2026-03-11)
Aetna·Radiation Oncology, Neurosurgery, Neurology +1 more·Medical Policy
Effective date
Mar 11, 2026
We identified it
Aug 17, 2026
Summary
Aetna has updated its Stereotactic Radiosurgery (SRS/SBRT) Clinical Policy Bulletin (CPB 0083) effective March 11, 2026. The policy clarifies covered CPT, HCPCS, and ICD-10 codes for stereotactic radiosurgery procedures and explicitly references eviCore Healthcare Radiation Therapy Clinical Guidelines for medical necessity determination. Key update: ICD-10 codes G40.001-G40.919 (Epilepsy), G44.001-G44.099 (Cluster headache/TAC), and R56.1, R56.9 (Seizures) are now explicitly NOT covered for SRS indications.
Action Required
By March 11, 2026: Billing team must (1) Update claim submission system to require prior authorization for all SRS/SBRT procedures using affected CPT/HCPCS codes only when medical necessity criteria from eviCore guidelines are met; (2) Configure billing software to DENY or flag claims with ICD-10 codes G40.001-G40.919, G44.001-G44.099, R56.1, or R56.9 paired with SRS procedure codes (these are explicitly non-covered); (3) Review and update internal documentation templates to reflect that eviCore Healthcare Radiation Therapy Clinical Guidelines govern medical necessity (note: eviCore may update guidelines without prior notice, with draft versions posted 90 days pre-implementation); (4) Train providers and billing staff on covered vs. non-covered indications to prevent claim denials; (5) Implement monitoring for seizure and cluster headache diagnoses submitted with SRS codes and reject or require diagnosis code correction before submission. Failure to implement these controls will result in claim denials for non-covered indications and potential compliance issues.