Aetna Burn Garments Policy Update (CPB 0062): What Billing Teams Need to Know for 2026

Aetna updated Clinical Policy Bulletin 0062 covering burn garments on January 17, 2026. This policy governs coverage for custom-fitted compression garments prescribed following burn injuries—a niche but clinically critical category that touches burn centers, wound care programs, occupational therapy practices, and durable medical equipment suppliers. If your organization bills for post-burn pressure garments, this modification warrants a careful review of your current documentation and prior authorization workflows.

What Is Aetna's CPB 0062 and Why Was It Modified?

Aetna, a CVS Health company, maintains Clinical Policy Bulletins (CPBs) as the formal framework governing medical necessity determinations across its commercial, Medicare Advantage, and managed Medicaid products. CPB 0062 specifically addresses burn garments—custom-fitted pressure garments used in the treatment of hypertrophic scarring following thermal injury.

The January 17, 2026 modification to CPB 0062 reflects Aetna's periodic review cycle, during which the insurer updates coverage criteria to align with current clinical evidence, professional society guidance, or internal utilization data. While the specific line-by-line changes have not been published in this summary, modifications to burn garment policies typically address one or more of the following areas: eligible diagnoses, documentation requirements for medical necessity, replacement frequency, body surface area thresholds, or the distinction between custom-fabricated and prefabricated garments.

Billing teams at burn centers and DME suppliers should treat any CPB modification as an opportunity to audit active claims and pending authorizations against the revised standard.

Burn Garment Coverage: What Aetna Generally Requires

Burn pressure garments—sometimes billed as custom compression garments or jobst-style garments—occupy a complex billing category. Coverage under Aetna's CPB 0062 has historically required documentation demonstrating that the garment is medically necessary for the treatment or prevention of hypertrophic scarring following a significant burn injury.

Key documentation elements that Aetna has consistently required in this policy area include:

• Diagnosis specificity: The treating diagnosis must reflect an acute or subacute burn injury with documented risk of hypertrophic scarring or keloid formation. Vague wound care diagnoses without burn etiology have historically been grounds for denial.
• Prescribing clinician documentation: Orders are generally required from a physician actively managing the burn injury—not simply a referring provider. Occupational therapists who fabricate garments must link their work to a qualifying physician order.
• Custom vs. prefabricated distinction: Custom-fabricated garments receive different coverage consideration than off-the-shelf compression garments. The clinical record must support why a custom fit is necessary, typically citing the wound location, body contour, or prior failure of a prefabricated option.
• Replacement frequency: Aetna's policies in this category typically specify allowable replacement intervals. Garments submitted more frequently than the policy permits will require additional documentation justifying accelerated wear or damage.

Because the full updated criteria for the January 17, 2026 revision are not detailed in this summary, billing and clinical teams should pull the complete CPB 0062 document directly from Aetna's provider portal before processing claims under this policy.

Affected Codes

The updated CPB 0062 policy document does not include specific CPT or HCPCS codes in the data available for this summary. Aetna's burn garment policies have historically referenced HCPCS Level II codes in the A-series (DME and supplies) and L-series (orthotic procedures), but billing teams should not rely on historically applicable codes without verifying against the current policy text.

To identify the exact codes covered, not covered, or subject to prior authorization under the revised CPB 0062, access the full policy at app.payerpolicy.org/p/aetna/0062 or Aetna's official provider portal.

The policy does not list specific codes in the data provided for this update.

Prior Authorization Considerations for Burn Garments

Custom burn garments have historically required prior authorization under most Aetna commercial and Medicare Advantage plans. A policy modification—even one that appears minor—can alter the authorization triggers, the required clinical information submitted with the auth request, or the review pathway (standard vs. expedited).

If your organization submits prior auth requests for burn garments, confirm the following against the updated CPB 0062:

• Whether prior authorization is still required for initial garments, replacements, or both
• What clinical documentation must accompany the authorization request (e.g., burn percentage, wound photos, prior treatment history)
• Whether any new diagnosis codes or clinical criteria have been added as qualifying conditions
• Whether the policy now draws distinctions between pediatric and adult patients, which is common in burn care given different growth-related garment replacement needs

Failing to align your auth submissions with the updated criteria is the single most direct path to denial—even when the clinical need is unambiguous.

What Your Billing Team Should Do