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Pudendal Nerve Decompression (CPB 0805, reviewed 2026-10-28)
Effective date
Not stated in the notice
Identified
Nov 2, 2026
Summary
Aetna's clinical policy bulletin 0805 on pudendal nerve decompression was reviewed on 10/28/2026. It treats pudendal nerve decompression, hydrodissection and neurolysis as experimental, investigational or unproven for chronic pelvic pain, pudendal neuralgia, interstitial cystitis, penile numbness and erectile dysfunction, persistent genital arousal disorder and vulvodynia, and it lists three related CPT codes as not covered for those indications. The source does not state an effective date for a change or describe a coverage change in this review.
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What to do
Action · 5 steps
01No source-stated effective date or future deadline applies to a change.
02Providers and front desk staff: before scheduling pudendal nerve decompression, hydrodissection or neurolysis, confirm the indication with the provider.
03For chronic pelvic pain, pudendal neuralgia, interstitial cystitis, penile numbness, persistent genital arousal disorder or vulvodynia, the policy treats the service as experimental and not covered, so tell the provider before the procedure is booked.
04Billing team: in charge entry and claim edits, review claims that pair 64430, 64630 or 64722 with the listed diagnosis codes, such as F52.21, N30.10 or R10.2, and send any flagged claim to the billing lead for review instead of submitting it as routine.
05Watch for Aetna's next update to this bulletin; the source lists its next review date as 09/09/2027.
Codes mentioned
644306463064722F52.21F52.22G57.00G57.93G58.8G58.9M54.10M54.18M79.2N30.10N30.11N39.3N39.41N39.498N48.89N52.01N52.9N94.810N94.819R10.2R10.24R20.2
Original notice
Pudendal Nerve Decompression (CPB 0805, reviewed 2026-10-28)
aetna.com · Always check the source before changing claims.
Related changes
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Related policy hubs
Aetna policiesPain ManagementUrologyOB-GYNCode 64430Code 64630Code 64722Code F52.21Code F52.22Code G57.00Code G57.93Code G58.8Code G58.9Code M54.10Code M54.18Code M79.2Code N30.10Code N30.11Code N39.3Code N39.41Code N39.498Code N48.89Code N52.01Code N52.9Code N94.810Code N94.819Code R10.2Code R10.24Code R20.2