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OfficeLink Updates - April 2026 notices and reminders (PDF)
Aetna·Cardiology, Endocrinology, General Surgery +3 more·Newsletter
Effective date
Jul 1, 2026
We identified it
Jun 19, 2026
Summary
Aetna is implementing multiple policy changes effective July 1, 2026, including updates to pharmacy drug lists, Combined Benefit Management drug list changes that may move specialty drugs between medical and pharmacy benefits, and new billing restrictions for reconstructive surgery codes when performed with breast or digestive system surgeries. Remote Physiologic Monitoring coverage is now limited to heart failure, hypertension, and diabetes only.
Action Required
By May 1, 2026: Review all patient treatment plans for affected specialty drugs and RPM services. Update billing workflows to handle drug benefit transfers between medical and pharmacy coverage. By July 1, 2026: Billing team must update system to deny reconstructive surgery codes 15733-15738 and 14000-14302 when billed same day as breast surgery (19300-19396) or digestive system surgery (40490-49999) by different providers. Update RPM billing to only cover heart failure, hypertension, and diabetes conditions with FDA-approved devices. Failure to comply will result in claim denials.