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In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-26)
Effective date
Not stated in the notice
Identified
Oct 30, 2026
Replaced. This version was replaced by In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-27) (published Oct 27, 2026).
Summary
Aetna Clinical Policy Bulletin 0783 addresses in vivo analysis of gastrointestinal and urothelial lesions. It considers confocal laser endomicroscopy, including Cellvizio probe-based confocal laser endomicroscopy, and in-vivo analysis of colorectal polyps experimental, investigational, or unproven for the indications listed, because the effectiveness of these approaches has not been established. The source lists CPT and ICD-10 codes as not covered for the indications in the policy and gives a last review date of 10/26/2026.
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What to do
Action · 2 steps
01Billing team: Do not bill CPT 43206, 43252 or +0397T for the indications listed in this policy, because the source states these codes are not covered for those indications.
02Before billing confocal laser endomicroscopy or in-vivo analysis of colorectal polyps, confirm the indication is not one the policy lists as experimental, investigational or unproven.
Codes mentioned
432064325245378G0105G0121B65.0C44.42C61D13.5J84.89K22.710K30K63.5K86.2K86.89Q43.1T86.810Z12.11Z12.89
Original notice
In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-26)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2025-12-11)MediumNo effective date · Medical PolicyIn Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-27)MediumNo effective date · Medical PolicyBarrett's Esophagus (CPB 0728, reviewed 2026-10-26)MediumNo effective date · Medical PolicyVirtual Gastrointestinal Endoscopy (CPB 0535, reviewed 2026-07-30)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesGastroenterologyPulmonologyUrologyENT (Ear, Nose & Throat)OncologyOB-GYNNeurosurgeryGeneral SurgeryPathologyCode 43206Code 43252Code 45378Code G0105Code G0121Code B65.0Code C44.42Code C61Code D13.5Code J84.89Code K22.710Code K30Code K63.5Code K86.2Code K86.89Code Q43.1Code T86.810Code Z12.11Code Z12.89