CommercialCoverageMedium impact
Female Sexual Dysfunction (FSD) (CPB 0574, reviewed 2026-09-10)
Aetna·OB-GYN, Psychiatry, Physical Therapy +1 more·Medical Policy
We identified it
Oct 2, 2026
Summary
Aetna has updated its Female Sexual Dysfunction (FSD) policy (CPB 0574) to clarify coverage and non-coverage of treatments. The policy covers cognitive behavioral therapy/psychotherapy (CPT 90832-90838) and pelvic floor physical therapy (CPT 97110) as medically necessary, while designating numerous interventions as experimental/investigational including laser therapy, radiofrequency procedures, stem cell therapies, and device-based treatments. Billing teams must ensure claims for non-covered procedures are denied appropriately and that covered psychotherapy and physical therapy codes are processed correctly when medically indicated.
Action Required
IMMEDIATELY: Billing team must implement denial logic in claim processing system for all non-covered FSD procedures including: CPT 0232T (platelet rich plasma), 0552T (low-level laser therapy), 0672T (radiofrequency remodeling), 17110-17111 (micro-ablative carbon dioxide laser), 64566 (tibial nerve stimulation), HCPCS J2590 (oxytocin), J7318-J7332 (hyaluronic acid derivatives), and P9020 (platelet rich plasma). Update claim edits to automatically deny these codes when billed with ICD-10 F52.x, N90.5, N94.x, N95.2, R10.2x, or R37 diagnoses. ALLOW billing for CPT 90832-90838 (psychotherapy) and CPT 97110 (therapeutic exercises/physical therapy) when billed with appropriate FSD-related diagnoses without prior authorization. Audit current A/R for improperly paid claims on experimental/investigational procedures and resubmit for denial recovery. Train billing staff on the distinction between covered (psychotherapy, pelvic floor PT) and non-covered (device-based, laser, regenerative medicine) treatments. Ensure system reflects that vibrators and certain DME are not covered per plan limitations.