CommercialCoverageMedium impact
Fetal Echocardiography and Magnetocardiography (CPB 0106, reviewed 2026-03-26)
Aetna·OB-GYN, Cardiology, Radiology +1 more·Medical Policy
Effective date
Mar 26, 2026
We identified it
Aug 17, 2026
Summary
Aetna has updated its fetal echocardiography and magnetocardiography policy (CPB 0106, effective 2026-03-26) with expanded coverage criteria for medically necessary fetal cardiac imaging. The policy now covers 23 specific indications including maternal diabetes, autoimmune conditions, fetal chromosomal abnormalities, drug exposures, and arrhythmia surveillance. Magnetocardiography using deep learning models remains experimental/investigational and is not covered.
Action Required
By March 26, 2026: Billing team must update authorization and claims processing systems to recognize the expanded medical necessity criteria for fetal echocardiography (CPT 76825, 76826, 76827, 76828, 93325). Implement prior authorization logic to require documentation of at least one covered indication before approving claims. Flag claims for CPT 0541T and 0542T (magnetocardiography) as non-covered/experimental and deny with specific reference to this policy update. Update provider education materials to clarify: (1) gestational diabetes is NOT covered, only pre-existing type 1 or type 2 diabetes; (2) SSRIs other than paroxetine are experimental; (3) repeat studies are only covered for specific findings (ductus arteriosus dependent lesions, heart block, hemodynamic compromise, etc.). Verify maternal and fetal ICD-10 diagnosis codes match covered indications before processing claims. Consequences: Claims submitted without documented medical necessity or with experimental indications will be denied, resulting in patient balance issues and rework.