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AetnaAll Plans · Coverage · Medical Policy · General Surgery, Gastroenterology, OncologyMedium impact

Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2025-11-26)

Effective date
Not stated in the notice
Identified
Aug 18, 2026

Summary

Aetna covers transanal endoscopic microsurgery (TEM) for benign rectal tumors (adenomas), low-risk Tis and T1 rectal carcinoma, and small rectal carcinoids less than 2 cm in diameter. Aetna considers TEM experimental, investigational, or unproven for other indications, including advanced rectal cancer, anorectal melanoma, benign rectal strictures, rectal prolapse and diverticula, rectal schwannoma, and recto-urinary and recto-vesical fistulas. The covered CPT code is 0184T, and the policy lists the ICD-10 codes that are covered if selection criteria are met and the codes not covered for the listed indications.

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What to do

Action · 3 steps
01Billing team: when billing CPT 0184T for TEM, confirm the diagnosis is one of the covered indications in the policy: benign rectal adenomas, low-risk Tis or T1 rectal carcinoma, or small rectal carcinoids less than 2 cm in diameter.
02Use the ICD-10 codes listed as covered if selection criteria are met.
03Claims for TEM for the indications the policy lists as experimental, investigational, or unproven are not covered.

Codes mentioned

C20D01.1D01.2D12.0D12.6D12.7D12.9B57.32C43.51C49.A0C49.A9D36.15K56.690K56.699K57.00K57.93K59.31K59.39K59.00K59.09K62.3K62.4K62.6K62.89N32.1N32.81N32.89N36.0Q42.1

Original notice

Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2025-11-26)
aetna.com · Always check the source before changing claims.
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Related changes

See all Aetna changes →
Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2026-10-21)MediumNo effective date · Medical PolicyTransrectal Ultrasound (CPB 0001, reviewed 2026-03-05)MediumNo effective date · RadiologyDefecography (CPB 0718, reviewed 2025-10-14)MediumNo effective date · Medical PolicyHigh-Resolution Anoscopy (CPB 0808, reviewed 2026-10-29)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesGeneral SurgeryGastroenterologyOncologyCode C20Code D01.1Code D01.2Code D12.0Code D12.6Code D12.7Code D12.9Code B57.32Code C43.51Code C49.A0Code C49.A9Code D36.15Code K56.690Code K56.699Code K57.00Code K57.93Code K59.31Code K59.39Code K59.00Code K59.09Code K62.3Code K62.4Code K62.6Code K62.89Code N32.1Code N32.81Code N32.89Code N36.0Code Q42.1

Summaries are AI-assisted. Always confirm against the original payer notice.

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