CommercialCoverageMedium impact
OfficeLink Updates - May 2025 notices and reminders (PDF)
Aetna·WA, TX, ME, VT · Urology, Pathology, Oncology·Newsletter
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Effective August 1, 2025, Aetna will no longer cover surgical pathology code 88305 when billed with prostate procedures 55700/55706 on the same date, and will limit G0416 to once per date of service. Additionally, effective July 1, 2025, certain specialty medications will move between medical and pharmacy benefits for fully insured commercial members.
Action Required
By August 1, 2025: Billing team must update system to prevent billing CPT 88305 with procedures 55700 and 55706 on same date of service, and limit G0416 to once per date. By July 1, 2025: Review specialty drug patients for benefit changes - may need to issue prescriptions to specialty pharmacies for drugs moving from medical to pharmacy benefit, or prepare for medical billing for drugs moving from pharmacy to medical benefit.