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Motor Cortex Stimulation (CPB 0755, reviewed 2026-10-21)
Effective date
Not stated in the notice
Identified
Oct 28, 2026
Summary
Aetna's Clinical Policy Bulletin 0755 says Aetna considers motor cortex stimulation experimental, investigational, or unproven for the listed indications because its effectiveness has not been established. The listed indications include amyotrophic lateral sclerosis, autism spectrum disorder, cerebral palsy, chronic refractory pain, depression, dysphagia, Parkinson's disease, post-stroke aphasia, post-stroke hemiparesis, seizures, traumatic brain injury and obsessive compulsive disorder, and the bulletin says that list is not all-inclusive. The bulletin also lists CPT, HCPCS and ICD-10 codes that are not covered for the indications listed in the policy.
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What to do
Action · 2 steps
01Billing team: For the indications this policy lists as experimental, investigational or unproven, do not bill motor cortex stimulation or the listed CPT and HCPCS codes as covered services, because the policy says these codes are not covered for those indications.
02Billing team: Compare each claim's diagnosis codes with the ICD-10 codes the policy lists as not covered for these indications, noting that the policy says that list is not all-inclusive.
Codes mentioned
618506186061885618866456895961959629597061781617826186361864618676186861880618887055170553705547055595927959659596796020C1607C1767C1778C1787C1816C1820C1883C1897E0745L8680L8681L8682L8683L8685L8686L8687L8688L8689L8695C1770F32.0F32.9F32.AF33.0F33.9F42.2F42.9F51.8F84.0F98.4G10G12.21G20G21.0G21.9G23.0G23.9G24.01G24.9G25.0G26G40.001G40.89G47.61G47.69G50.0G50.1G54.6G54.7G60.0G60.9G80.0G80.9G89.0G89.21G89.29G89.3G89.4G90.3G90.50G90.59I69.051I69.059I69.151I69.159I69.251I69.259I69.351I69.359I69.851I69.859I69.951I69.959I69.320R13.0R13.10R25.0R25.9S06.0X0AS06.A1XS
Original notice
Motor Cortex Stimulation (CPB 0755, reviewed 2026-10-21)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Motor Cortex Stimulation (CPB 0755, reviewed 2026-02-24)MediumNo effective date · Medical PolicyDeep Brain Stimulation (CPB 0208, reviewed 2026-03-27)MediumNo effective date · Medical PolicySpasticity Management (CPB 0362, reviewed 2026-05-26)MediumNo effective date · Medical PolicySpinal Cord Stimulation (CPB 0194, reviewed 2026-09-10)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
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