CommercialCoverageMedium impact
Median Arcuate Ligament Syndrome: Treatment (CPB 1092)
Aetna·Vascular Surgery, General Surgery, Gastroenterology +2 more·Medical Policy
We identified it
Oct 4, 2026
Summary
Aetna has issued a new medical policy (CPB 1092) establishing coverage criteria for Median Arcuate Ligament Syndrome (MALS) treatment. The policy covers surgical decompression, percutaneous/surgical revascularization, and celiac plexus nerve blocks when specific diagnostic and clinical criteria are met, but classifies gastric tonometry as experimental. Billing teams must verify all prerequisite imaging and psychiatric assessments are documented before submitting claims for these procedures.
Action Required
Immediately: Billing team must implement prior authorization procedures for MALS treatment claims. For all CPT codes 35631, 35632, 37236, 37237, and 64530, require documentation of: (1) symptomatic postprandial abdominal pain; (2) duplex ultrasound results showing increased flow velocities (celiac artery >200 cm/sec and/or SMA >275 cm/sec); (3) cross-sectional imaging (CT or MR) suggestive of compression; (4) CTA or MRA confirming focal narrowing with hooked/J-shaped appearance; (5) preoperative psychiatric/behavioral health assessment. For revascularization procedures (CPT 37236, 37237), additionally verify post-decompression status, refractory pain documentation, and imaging confirmation of persistent stenosis (PSV >200 cm/sec on duplex or >30% residual stenosis on CTA/MRA). Do NOT cover gastric tonometry claims under any diagnosis code. Update billing software to flag and hold claims missing any required documentation elements. Attach checklist to encounter forms for providers performing MALS procedures. Failure to obtain complete documentation will result in claim denials.