CommercialCoverageMedium impact
Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation (CPB 0599, reviewed 2025-09-10)
Aetna·Cardiology, Cardiothoracic Surgery, Neurology +9 more·Medical Policy
Effective date
Sep 10, 2025
We identified it
Aug 18, 2026
Summary
Aetna has updated Clinical Policy Bulletin 0599 to designate autologous skeletal myoblast and mononuclear bone marrow cell transplantation procedures as experimental, investigational, or unproven across a comprehensive list of indications including cardiac diseases, orthopedic conditions, neurological disorders, and other specified conditions. These procedures are not covered under this policy, and claims for the listed CPT, HCPCS, and ICD-10 codes will be denied when billed for the non-covered indications.
Action Required
By September 10, 2025, billing and clinical staff must: (1) Update billing software to flag claims for CPT codes 0263T, 0264T, 0265T, 38240, 38241, and HCPCS code C9782 as non-covered when submitted with any ICD-10 diagnosis code listed in the policy (cardiac, orthopedic, neurological, metabolic, and other specified conditions); (2) Create an internal reference guide listing all non-covered indications to prevent claim submission; (3) Notify providers that these procedures require prior authorization verification before scheduling and that claims will be automatically denied if billed for the listed indications; (4) Update denial response letters to reference CPB 0599 and clarify experimental/investigational status. Billing team must implement system edits immediately upon policy effective date. Providers should direct patient inquiries regarding coverage to Aetna directly. Claims submitted after the effective date for non-covered indications will result in denials and potential patient balance issues.