CommercialCoverageMedium impact
Total Body Plethysmography (CPB 0474, reviewed 2026-07-17)
Aetna·Pulmonology, Internal Medicine, Family Medicine +1 more·Medical Policy
Effective date
Jul 17, 2026
We identified it
Aug 18, 2026
Summary
Aetna has updated its Total Body Plethysmography (CPT 94726) medical policy effective 2026-07-17, clearly defining six covered indications and explicitly listing six non-covered experimental uses. Billing teams must verify claims include one of the six qualifying diagnoses and reject or require clinical justification for all non-covered indications (primary pulmonary hypertension, systemic sclerosis, scoliosis, pectus excavatum, bleomycin monitoring, and asymptomatic COPD screening).
Action Required
By 2026-07-17, billing team must update claim review procedures: (1) Configure billing system to flag CPT 94726 claims and require validation that at least one of the six covered ICD-10 diagnoses is present (D86.0-D86.9 for sarcoidosis, E84.0-E84.9 for cystic fibrosis, J09.X1-J22 and J40-J99 for respiratory conditions); (2) Automatically deny or request clinical documentation for claims with non-covered diagnoses (I27.0 primary pulmonary hypertension, M34.0-M34.9 systemic sclerosis, M41.00-M41.9 scoliosis, Q67.6 pectus excavatum, Z13.83 asymptomatic COPD screening, Z51.81 bleomycin monitoring); (3) Notify providers that plethysmography is covered ONLY when used as adjunct to complete pulmonary function testing for one of six specific indications (bronchial hyper-reactivity determination, bronchodilator response in clinical responders with normal FEV1, obstructive lung disease evaluation, airflow resistance measurement, lung volume measurement to distinguish restrictive vs. obstructive disease, or cases requiring repeated trials or inability to perform multi-breath tests); (4) Rejection reason: 'Total body plethysmography is experimental/investigational for this indication per Aetna CPB 0474.' Failure to apply these restrictions will result in claim denials on retrospective audit.