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AetnaCommercial · Coverage · Medical Policy · Anesthesiology, Pain Management, Emergency MedicineMedium impact

Sufentanil Sublingual Tablet (Dsuvia) (CPB 0944, reviewed 2026-10-09)

Effective date
Not stated in the notice
Identified
Oct 12, 2026

Summary

Aetna Clinical Policy Bulletin 0944 covers the sufentanil sublingual tablet (Dsuvia) for commercial medical plans. Aetna considers Dsuvia not medically necessary for the treatment of acute pain severe enough to require an opioid analgesic because safety for this indication has not been established, and experimental, investigational, or unproven for all other indications. Dsuvia is administered by a healthcare provider in a certified medically supervised healthcare setting, such as hospitals, surgical centers, and emergency departments, at a recommended dose of 30 mcg sublingually and is not for home use or for use in children.

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What to do

Action · 3 steps
01Already effective 2019-02-18: Billing team: Claims for Dsuvia for acute pain severe enough to require an opioid analgesic are not medically necessary under this Aetna policy, because safety for this indication has not been established.
02Claims for Dsuvia for all other indications are considered experimental, investigational, or unproven, because safety and effectiveness have not been established in the peer-reviewed published medical literature.
03Check current applicability of this policy at the source link before billing Dsuvia claims.

Codes mentioned

G89.11G89.18

Original notice

Sufentanil Sublingual Tablet (Dsuvia) (CPB 0944, reviewed 2026-10-09)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesAnesthesiologyPain ManagementEmergency MedicineCode G89.11Code G89.18

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