Autoimmune Antibody and Coagulation Testing (CPB 0662, reviewed 2026-10-14)

Billing team should verify current applicability of this policy review (dated 2026-10-14) by contacting Aetna directly to confirm whether an explicit effective date has been established since publication. Update billing system and prior authorization protocols to reflect the covered codes (0275U, 0279U, 0280U, 0283U, 0284U) and their medical necessity criteria: PF4-dependent P-selectin assay requires suspected HIT diagnosis; VWF collagen binding assays (CPT 0279U, 0280U) require suspected type 2A, 2B, or 2M VWD; VWF-FVIII binding assay (CPT 0284U) requires suspected type 2N VWD; VWF multimer analysis and RIPA require diagnosed VWD. Flag CPT 0281U (VWF propeptide antigen) and antiprothrombin antibody testing as non-covered experimental/investigational tests and deny claims submitted for these services unless prior authorization documentation from Aetna explicitly approves coverage for individual cases. Coordinate with clinical staff to ensure providers understand that diagnosis codes D68.61 (antiphospholipid syndrome), N96 (recurrent pregnancy loss), and O26.20-O26.23 (pregnancy care for recurrent loss) are listed as NOT covered indications for antiprothrombin antibody testing.