By January 14, 2026: Billing team must immediately implement the following: (1) Update billing system to flag and DENY claims for the following non-covered experimental/investigational tests unless prior authorization is obtained from Aetna: mNGS tests (IDbyDNA AlloID, Karius Test, Johns Hopkins mNGS, Mayo MSCSF Test, MicroGenDX variants, NeXGen Fungal/AFB), multiplex immunoassay panels (Accelerate PhenoTest BC Kit variants, FebriDx, IntelliSep, MeMed BV), and other tests (bacterial typing/whole genome sequencing for outbreak investigation, monocyte distribution width/Early Sepsis Indicator, ciprofloxacin/macrolide resistance testing, BIOTIA-ID, FidaLab, IVD CAPSULE PSP, LifeScale Gram Negative Kit, Synovasure PJI Panel, TriVerity, TrexAB). (2) Ensure CPT codes 0035U and 0584U (RT-QuIC prion disease testing) remain COVERED when ICD-10 diagnoses A81.00-A81.09, A81.81-A81.89, A81.9, or F02.80/F02.A0/F02.B0/F02.C0 are documented. (3) Ensure CPT codes 0064U, 0065U, 0210U, 86592, 86593, 86780, and 87285 (syphilis testing) remain COVERED for pregnant women and at-risk populations. (4) Providers and laboratory must NOT submit claims for experimental mNGS and multiplex panels without prior authorization; claims will be denied. (5) Update laboratory requisition forms and EMR templates to indicate which infectious disease tests require prior authorization. Contact Aetna for prior authorization before ordering experimental tests to prevent claim denials and patient liability.