CommercialCoverageHigh impact
Intradiscal Procedures (CPB 0602, reviewed 2025-09-10)
Aetna·Pain Management, Orthopedics, Neurosurgery +1 more·Medical Policy
Effective date
Sep 10, 2025
We identified it
Aug 16, 2026
Summary
Aetna has reaffirmed that thermal intradiscal procedures (TIPs) and numerous intradiscal injection therapies remain experimental, investigational, or unproven and are NOT covered. This policy, reviewed September 10, 2025, designates specific CPT/HCPCS codes as non-covered for listed indications. Billing teams must ensure claims for these procedures are denied or require explicit prior authorization denial rather than submission.
Action Required
By September 24, 2025: Billing team must update claim submission protocols to automatically DENY or flag for prior authorization denial the following intradiscal procedure codes: 22526, 22527, 62287, 0232T, 0481T, 0627T, 0628T, 0629T, 0630T, S2348, G0460, P9020, S2142, S2150 when billed for any intradiscal injection, thermal ablation, or decompression indication. Update your Aetna Claim Scrubber to reflect CPB 0602 as of 2025-09-10. Do NOT submit claims for these procedures without explicit Aetna prior authorization first. Create a provider alert bulletin explaining that intradiscal procedures (including thermal techniques, platelet-rich plasma injections, stem cell injections, condoliase, DiscoGel, GelStix, and bone marrow concentrate injections) are non-covered. Train front-desk and provider staff to obtain pre-authorization BEFORE scheduling. Failure to obtain authorization will result in patient balance bills and claim denials. Reference CPB 0602 on all denial communications.