Payer PolicyActive
Metabolic and Environmental Profiling and Imaging for Kidney Stone Risk
AETNA-CPB-0392
Aetna
Effective: June 6, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Metabolic and environmental profiling (including calcifying nanoparticles and genetic/molecular analyses) and CT/MRI for urolithiasis screening in asymptomatic persons are considered experimental/investigational and not covered; pelvic CT/MRI CPT codes 72192–72197 are specifically not covered for these indications. Tests associated with ICD‑10 R82.991–R82.998 may be covered only if the policy’s specific selection criteria are met.
Coverage Criteria Preview
Key requirements from the full policy
"ICD-10 codes R82."
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