G2169 Insurance Policy Changes

Occupational Therapy (CPB 0250, reviewed 2026-05-19)

Aetna updated its Occupational Therapy medical policy (CPB 0250) effective 2026-05-19, reinforcing strict medical necessity criteria requiring documented improvement within 1 month, written plans of care, licensed provider supervision, and explicit discontinuation when maximal benefit is achieved or progress plateaus. Billing teams must ensure all OT claims include detailed documentation of medical necessity and measurable progress to avoid denials.