CommercialCoverageHigh impact
Bone Mass Measurements (CPB 0134, reviewed 2026-03-19)
Aetna·Endocrinology, Geriatrics, Oncology +4 more·Medical Policy
Effective date
Mar 19, 2026
We identified it
Aug 19, 2026
Summary
Aetna updated its bone mass measurement policy (CPB 0134, reviewed 2026-03-19) to clarify covered indications, establish frequency limits (typically not more than once every 2 years), and explicitly exclude experimental technologies including finite element analysis (CPT 0554T-0557T, 0743T), deep learning-based QCT, cone beam CT, REMS (CPT 0815T), and AI-assisted vertebral fracture detection software. Billing teams must immediately stop billing excluded codes and enforce frequency restrictions in their authorization workflows.
Action Required
By 2026-04-19: (1) Billing team must update denial rules in billing system to automatically reject claims for non-covered codes: CPT 0554T, 0555T, 0556T, 0557T, 0743T (finite element analysis), CPT 0815T (REMS ultrasound), CPT 0691T (AI vertebral fracture assessment), CPT 0749T, 0750T (DXR-BMD), and any billing codes for cone beam CT, deep learning-based QCT, DPA, DXL, SPA, pulse-echo ultrasound, AGE measurement, or urinary phthalate testing. (2) Implement frequency restriction logic in prior authorization system: CPT 77080, 77081, 77085, 77086, 77089 are covered only once every 2 years EXCEPT for patients on glucocorticoids >3 months, anticonvulsants >3 months, or with uncorrected hyperparathyroidism (more frequent allowed). (3) Providers must document one of the 13 covered indications in medical records before billing; claims missing qualifying diagnosis will be denied. (4) Prior authorization team must review all bone mass measurement requests to verify covered indication and 2-year frequency compliance. Failure to implement these restrictions will result in claim denials and patient balance issues.