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CommercialCoverageMedium impact

Breast Reconstructive Surgery (CPB 0185, reviewed 2026-10-20)

Aetna·Plastic Surgery, General Surgery, Oncology·Surgery
Effective date
Not stated
We identified it
Oct 25, 2026
Days to comply
—

Summary

This is a policy review (not a change) of Aetna's Clinical Policy Bulletin 0185 on Breast Reconstructive Surgery, last reviewed 2026-10-20. The document outlines covered procedures, acellular dermal matrices, CPT/HCPCS codes, and experimental procedures. No new effective date or policy modification is stated—this appears to be a routine review publication. Billing teams should verify current applicability against their existing implementation and confirm whether their Aetna plans have adopted or modified any of these criteria.

Action Required

Action needed
Verify current applicability: The billing team should confirm whether this Aetna policy bulletin (CPB 0185, reviewed 2026-10-20) has been implemented or superseded in your practice's billing system and contracts. Cross-reference the listed covered CPT codes (19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, and others) and approved acellular dermal matrices (Alloderm, Cortiva, DermACELL, DermaMatrix, FlexHD, Strattice, SurgiMend) against your current prior authorization protocols and fee schedules. Ensure that experimental procedures listed (Artia Reconstructive Tissue Matrix, Biodesign Nipple Reconstruction, SimpliDerm, 3D volumetric imaging, venous super-charging) are flagged as non-covered in billing software. Note plan-specific exceptions stated in the policy: 'Many Aetna plans specify that certain surgeries are not considered cosmetic (e.g., surgery to correct injury, post-mastectomy breast reconstruction, breast augmentation to treat gender dysphoria)—check benefit plan descriptions for details.' No deadline is stated; this is routine policy documentation. No specific consequences are stated for non-compliance beyond standard denial protocols.

Affected Billing Codes

11920
11921
11922
11950
11951
11952
11953
11954
11970
11971
15769
15771
15772
15773
15774
15777
15877
19316
19318
19325
19328
19330
19340
19342
19350
19355
19357
19361
19364
19367
19368
19369
19370
19371
19380
19396
64910
64911
64912
64913