CommercialCoverageMedium impact
Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction (CPB 0351, reviewed 2026-05-21)
Aetna·Hematology, Oncology, Pathology +2 more·Genetic Testing
Effective date
May 21, 2026
We identified it
Aug 17, 2026
Summary
Aetna updated its flow cytometry policy (CPB 0351) effective 2026-05-21, clarifying coverage criteria for flow cytometry, ektacytometry, DNA ploidy, and S-phase fraction testing. The policy designates certain cancer-related ploidy/S-phase tests and microfluidic adhesion assays as experimental/investigational, while maintaining coverage for immunophenotyping and cell surface marker testing under specified conditions. Billing teams must ensure claims align with the specific ICD-10 diagnosis codes and clinical indications listed as covered.
Action Required
By 2026-05-21: Billing team must update claim edits and billing software to enforce Aetna's coverage criteria for flow cytometry codes. SPECIFIC ACTIONS: (1) For CPT codes 88182, 88184-88189, 86360, and 0305U: Verify ICD-10 diagnosis codes match the covered conditions list before submission; reject or flag claims with unsupported diagnoses (e.g., breast cancer C50.011-C50.A2, colorectal cancer C18.0-C21.8, lung cancer C34.00-C34.92, cervical cancer C53.0-C53.9, pediatric intracranial tumors). (2) For CPT codes 0121U, 0122U, 0303U, 0304U, 0606U: Block or deny all claims—these are listed as experimental/investigational and not covered for any indication. (3) For ploidy/S-phase fraction testing (CPT 88182): Limit coverage to the 9 specified localized cancers (endometrial, gastric, mediastinal neuroblastoma, medulloblastoma, ovarian, partial hydatidiform mole, prostate, renal cell, bladder) WITHOUT metastatic disease. (4) Update provider documentation requirements to confirm that prognostic information will affect treatment decisions before performing test. Failure to enforce these edits will result in claim denials and payment recoupture.