CommercialCoverageHigh impact
Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-06-18)
Aetna·Gastroenterology, Internal Medicine, Infectious Disease +1 more·Medical Policy
Effective date
Jun 18, 2026
We identified it
Aug 18, 2026
Summary
Aetna has updated its Clinical Policy Bulletin 0690 on noninvasive hepatic fibrosis testing, effective immediately. The policy establishes coverage criteria for four medically necessary tests (transient elastography/FibroScan, FibroTest-ActiTest/HCV-FibroSure, magnetic resonance elastography, and Enhanced Liver Fibrosis test) with frequency limits of no more than twice per year and restrictions on testing within 6 months of liver biopsy. Multiple investigational tests are now explicitly listed as not covered, requiring billing teams to deny or redirect claims for these services.
Action Required
By June 18, 2026: Billing team must immediately update claim scrubbing and authorization rules in the billing system to enforce these requirements: (1) Limit transient elastography claims (CPT 76981, 91200) to maximum twice per year per patient, and deny if performed within 6 months of a liver biopsy; (2) Deny CPT 76982 and 76983 in all cases; (3) Apply identical frequency and timing restrictions to FibroTest-ActiTest/HCV-FibroSure (CPT 81596) and magnetic resonance elastography (CPT 76391); (4) Create hard stops in billing software to automatically deny claims for experimental/investigational tests including ARFI, artificial intelligence-based fibrosis assessment, NASHnext, OWLiver Panel, quantitative MR (LiverMultiScan), and all serum marker panels not explicitly listed as covered (e.g., MFAP4, miRNA panels, MicroRNA-21, etc.); (5) Update prior authorization templates to require documented indication from covered ICD-10 codes (hepatitis B/C, Wilson's disease, hemochromatosis, NAFLD/NASH/MASH, primary sclerosing cholangitis) and deny claims with non-covered indications (glycogenic hepatopathy, alpha-1 antitrypsin deficiency, esophageal varices, portal hypertension, Alagille syndrome, Gilbert syndrome, liver transplant status). Providers and front desk staff should be notified that claims for non-covered tests will be denied. Failure to implement these restrictions will result in claim denials and potential overpayment recovery.