CommercialCoverageMedium impact
High-Resolution Anoscopy (CPB 0808, reviewed 2025-11-20)
Aetna·Gastroenterology, General Surgery, Infectious Disease +1 more·Medical Policy
Effective date
Nov 20, 2025
We identified it
Aug 17, 2026
Summary
Aetna has updated its High-Resolution Anoscopy (HRA) policy (CPB 0808) effective 2025-11-20, clarifying coverage for diagnostic HRA and biopsy/ablation guidance for suspicious anal lesions and high-grade anal intraepithelial neoplasia, while explicitly designating screening and surveillance procedures as experimental/investigational and therefore non-covered. Billing teams must ensure claims are coded correctly with proper ICD-10 diagnosis codes and reject or deny claims for non-covered screening/surveillance indications.
Action Required
By 2025-11-20, billing team must: (1) Update billing system rules to require specific covered diagnosis codes (A63.0, C21.0-C21.1, C44.520, C78.5, D01.3, D12.7-D12.9, K62.0-K62.1, K62.5-K62.89, R85.610-R85.619, R85.81, R85.82) for CPT 46601 and 46607 to be reimbursed; (2) Configure system to auto-deny or flag for manual review any claims with non-covered diagnosis codes including Z12.10-Z12.13, Z12.89, Z12.9 (screening indications) or Z85.048 (surveillance after treatment) paired with CPT 46601/46607; (3) Add claim edits to reject HRA procedures when diagnosis codes indicate asymptomatic screening, surveillance-only intent, or risk estimation for anal cancer treatment failure; (4) Communicate to providers and coders that only diagnostic HRA for suspicious lesions and HRA for biopsy/ablation guidance are covered—screening and surveillance uses are non-covered experimental procedures. Claims submitted without proper covered diagnosis codes or with excluded screening/surveillance codes will be denied.