Payer PolicyActive
Selected Kidney Function Tests
AETNA-CPB-0775
Aetna
Effective: October 11, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Aetna considers several selected kidney‑function tests — including APOL1 renal‑risk genotyping, the GFR NMR panel, KidneyIntelX, NaviDKD, PromarkerD, RenalVysion, and transdermal pyrazine‑based GFR measurement — experimental/investigational and not covered. Specific noncovered codes include CPT 0105U (KidneyIntelX), 0259U (GFR NMR), 0602T/0603T (transdermal GFR) and associated ICD‑10 ranges for type 2 diabetes and kidney disease (eg, E11.x, E11.21–E11.29, N18.1–N18.9, N17.0, N19, R94.4) for the indications listed.
Coverage Criteria Preview
Key requirements from the full policy
"KidneyIntelX: CPT code not covered for indications listed in the CPB: 0105U — "Nephrology (chronic kidney disease), multiplex electrochemiluminescent immunoassay (ECLIA) of tumor necrosis factor re..."
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