All PlansCoverageMedium impact
Oral Screening and Lesion Identification Systems (CPB 0760, reviewed 2026-10-21)
Aetna·Dentistry, Oncology, ENT (Ear, Nose & Throat) +1 more·Medical Policy
We identified it
Oct 23, 2026
Summary
Aetna's CPB 0760 policy (reviewed 2026-10-21) classifies oral screening and lesion identification systems as experimental, investigational, or unproven. This includes AI-based technologies, salivary biomarkers, EBV/HPV testing for oral cancer screening, and optical imaging systems (ViziLite, VELscope, Microlux DL, etc.). Specific CPT and HCPCS codes for these procedures are not covered under the listed indications and should be denied or require prior authorization review.
Action Required
Billing team should implement denial logic or prior authorization requirements for the listed CPT, HCPCS, and dental codes (0429U, 40899, 41599, 41899, 82397, 87623, 87624, 87625, 87626, D0431, G0476, 86663-86665) when submitted for oral cancer screening, lesion identification, or detection of oral squamous cell carcinomas using artificial intelligence, salivary biomarkers, EBV testing, HPV testing, chemiluminescence, optical imaging, or related technologies. Verify in the billing system that claims with these codes linked to the non-covered ICD-10 indications (C00.0-C10.9, D00.00-D00.08, D37.01-D37.09, Z12.81, or oral/salivary gland diseases) are flagged for denial. Update encounter templates and provider documentation guidelines to clarify that these screening modalities are not covered and may result in patient responsibility if performed. Confirm current applicability with Aetna by plan and member state, as the policy review date (2026-10-21) does not indicate a new effective date; the policy may have been in effect prior to this review.