CommercialCoverageMedium impact
Hemodialysis for Schizophrenia (CPB 0291, reviewed 2026-04-17)
Aetna·Psychiatry, Nephrology·Medical Policy
Effective date
Oct 13, 1998
We identified it
Aug 17, 2026
Summary
Aetna has reaffirmed that hemodialysis is NOT covered for schizophrenia treatment due to lack of clinical evidence. CPT codes 90935, 90937, and 90940, when billed with ICD-10 codes F20.0-F20.9 (schizophrenia) or F25.0-F25.9 (schizoaffective disorders), will be denied. Billing teams must ensure claims for these combinations are rejected at the system level to prevent submission and denial.
Action Required
Immediately: Billing team must update billing system denial rules to automatically reject all claims combining CPT codes 90935, 90937, or 90940 with ICD-10 diagnosis codes F20.0-F20.9, F25.0-F25.9, or Z49.01-Z49.32 (dialysis encounters for schizophrenia/schizoaffective disorders). Add system flag to prevent submission of these code combinations to Aetna plans. Communicate to providers that hemodialysis for schizophrenia treatment is experimental and non-covered; these claims will be denied if submitted. Update internal policies and encounter templates to reflect non-coverage. Failure to implement system-level denials will result in claim rejections and may trigger compliance issues.