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Spinal Ultrasound (CPB 0628, reviewed 2026-09-11)

Aetna·Radiology, Pediatrics, Neurosurgery +1 more·Radiology
Effective date
Not stated
We identified it
Oct 4, 2026
Days to comply
—

Summary

Aetna's Spinal Ultrasound policy (CPB 0628) clarifies that CPT 76800 is covered ONLY for newborns and infants with specific clinical indications (spinal dysraphism, birth injury sequelae, cord tethering, etc.) and intraoperatively. All other uses of spinal ultrasound—including for adult neuro-musculoskeletal conditions, scoliosis evaluation, epidural/subarachnoid block guidance, and spinal muscular atrophy—are classified as experimental/investigational and not covered. Billing teams must ensure claims for CPT 76800 include appropriate newborn/infant ICD-10 codes or will face denials.

Action Required

Action needed
Immediately: Billing team must implement claim edits in the billing system to deny or require manual review of all CPT 76800 claims that do NOT include at least one ICD-10 code from the covered list (P10.x, P11.5, P52.x, Q05.x, Q06.x, Q07.0x, Q42.2, Q42.3, Q76.49, G96.0x, G97.51, G97.61, G97.63). Specifically: (1) Update claim submission rules to flag CPT 76800 with diagnosis codes G06.1, G12.x, G54.x, G59, G60.x-G65.2, G70.x-G73.7, M41.x, M50.x, M51.x, M53.x, M54.x as NON-COVERED (experimental/investigational); (2) Create pre-billing checklist for providers documenting CPT 76800 must include newborn/infant age or intraoperative status AND covered ICD-10 diagnosis; (3) Train front-desk and coding staff that adult spinal ultrasound for back pain, radiculopathy, scoliosis, epidural blocks, or abscess evaluation will be denied; (4) Communicate to providers that CPT 76800 is limited to neonates/infants only for diagnostic purposes. Failure to implement these edits will result in high claim denial rates and payment recoupment requests.

Affected Billing Codes

76800
G96.00
G96.01
G96.02
G96.09
G97.51
G97.61
G97.63
P10.0
P10.1
P10.2
P10.3
P10.8
P10.9
P11.5
P52.0
P52.1
P52.21
P52.22
P52.3
P52.5
Q05.0
Q05.1
Q05.2
Q05.3
Q05.4
Q05.5
Q05.6
Q05.7
Q05.8
Q05.9
Q06.0
Q06.1
Q06.2
Q06.3
Q06.4
Q06.8
Q06.9
Q07.01
Q07.02
Q07.03
Q42.2
Q42.3
Q76.49