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Guillain-Barre Syndrome Treatments (CPB 0732, reviewed 2026-10-21)

Aetna·Neurology, Critical Care, Pulmonology +1 more·Medical Policy
Effective date
Not stated
We identified it
Oct 26, 2026
Days to comply
—

Summary

This is a policy review (not a change) of Aetna's Clinical Policy Bulletin 0732 on Guillain-Barré Syndrome treatments, last reviewed 2026-10-21. The policy specifies that IVIG, plasmapheresis, and pulmonary rehabilitation are medically necessary when criteria in related CPBs are met, while corticosteroids, eculizumab, rituximab, and other agents remain experimental/investigational. No effective date or policy modification is stated in the source document.

Action Required

Action needed
Verify current applicability of this policy review with Aetna. Confirm that billing staff correctly apply Aetna's coverage determinations for GBS treatments: (1) CPT 36514 and HCPCS codes J1561, J1566, J1568, J1569 (IVIG administration and immunoglobulin products) are covered only when criteria in CPB 0206 are met; (2) CPT 97810–97814 and S9473 (pulmonary rehabilitation) are covered only when criteria in CPB 0032 are met; (3) CPT 36514 (plasmapheresis) is covered only when criteria in CPB 0285 are met; (4) All HCPCS codes listed for corticosteroids (J0702, J1020, J1030, J1040, J1094, J1100, J1700, J1710, J1720, J2920, J2930, J3300–J3303, J7509, J7510, J7512, J8540), eculizumab (J1299), interferons (J9212–J9216), leukocyte trafficking inhibitors (J2323, J3380, Q5134), rituximab (J9312), acupuncture (97810–97814, S8930), and neuromuscular electrical stimulation (S8930) are NOT covered for GBS treatment as they remain experimental/investigational per this policy. Update claim rejection logic and prior authorization protocols in billing software to deny or require prior auth as appropriate, and educate providers on covered versus non-covered treatment options.

Affected Billing Codes

36514
90283
97810
97811
97812
97813
97814
J1561
J1566
J1568
J1569
S9473
J0202
J0702
J1020
J1030
J1040
J1094
J1100
J1299
J1700
J1710
J1720
J2323
J2650
J2920
J2930
J3300
J3301
J3302
J3303
J3380
J7509
J7510
J7512
J8540
J9212
J9213
J9214
J9215
J9216
J9312
Q3027
Q5134
S8930
S9559
G61.0