CommercialCoverageHigh impact
Lung Imaging: Selected Techniques (CPB 0581, reviewed 2026-02-24)
Aetna·Pulmonology, Radiology, Oncology +1 more·Radiology
Effective date
Feb 24, 2026
We identified it
Aug 18, 2026
Summary
Aetna's updated Lung Imaging policy (CPB 0581, effective 2026-02-24) clarifies coverage for Lung Imaging Fluorescence Endoscopy (LIFE) as medically necessary for specific lung cancer detection scenarios, while designating multiple advanced imaging modalities (CALIPER, contrast-enhanced ultrasound, 3D lung CT, Xenon Xe-129, and others) as experimental/investigational and not covered. Billing teams must immediately stop billing non-covered imaging codes and ensure prior authorization documentation for covered LIFE procedures in eligible patient populations.
Action Required
IMMEDIATE (effective 2026-02-24): Billing team must update system to deny or require prior authorization for experimental/investigational codes (0807T, 0808T, 0877T, 0878T, 0879T, 0880T, 76978, 76979, A9610, C9791) for ALL indications. For LIFE bronchoscopy procedures (CPT 31622-31640 with LIFE enhancement), implement prior authorization requirements only when patient meets ONE of these criteria: (1) known/previously diagnosed lung cancer, (2) suspected lung cancer with positive sputum cytology, hemoptysis, infiltrates, unresolved pneumonia >30 days, persistent cough, or positive X-ray, or (3) prior resected Stage I lung cancer with no metastatic disease. Providers must document medical necessity using eligible ICD-10 codes (C34.00-C34.92, D02.20-D02.22, C78.00-C78.02, Z85.118) on all claims. Add required documentation checklist to encounter forms for pulmonology/bronchoscopy cases. Claims for non-covered modalities (CALIPER, contrast ultrasound, 3D lung CT, Xenon Xe-129) will be denied. Update denial templates and staff communication. Verify all claims include proper qualifying diagnosis and indication documentation before submission to avoid denials.