J2597 Insurance Policy Changes

Enuresis (CPB 0431, reviewed 2026-07-01)

Aetna updated its enuresis treatment policy (CPB 0431, effective 2026-07-01) to establish specific medical necessity criteria for bedwetting alarms and desmopressin in children 7 years and older. The policy designates numerous alternative therapies (acupuncture, adenoidectomy, tonsillectomy, hypnosis, chiropractic, TENS, clonidine, and others) as experimental/investigational and not covered. Billing teams must immediately halt claims for non-covered procedures and enforce strict documentation requirements for covered treatments.