CommercialCoverageMedium impact
Kidney Stones: Selected Interventions (CPB 0392, reviewed 2026-06-23)
Aetna·Urology, Nephrology, Radiology·Medical Policy
Effective date
Jun 23, 2026
We identified it
Aug 19, 2026
Summary
Aetna has updated its kidney stone policy (CPB 0392, effective 2026-06-23) to designate four interventions as experimental/investigational and not covered: acoustic enhancer microbubble cavitation lithotripsy (CPT 0991T), CT/MRI screening for asymptomatic urolithiasis (CPT 72192-72197), calcifying nanoparticles for risk assessment, and genetic/molecular analysis for risk assessment. Billing teams must deny claims for these specific codes when submitted for the listed indications and ensure prior authorization workflows reflect non-coverage status.
Action Required
By 2026-06-23: Billing team must update claim denial rules in billing software to automatically deny or flag CPT codes 0991T, 72192, 72193, 72194, 72195, 72196, and 72197 when billed for kidney stone screening or risk assessment indications. Update prior authorization system to reflect non-coverage status for these codes. Providers should be notified that these interventions are experimental/investigational and not reimbursable. Claims submitted for these codes will be denied as non-covered services. Front desk and billing staff must educate patients that these procedures are not covered under Aetna plans.