Aetna modified CPB 0235 covering plantar fasciitis treatments, effective September 26, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated CPB 0235 — its coverage policy for plantar fasciitis treatments — with a September 26, 2025 effective date. The policy governs medical necessity criteria for CPT 20550 (steroid/anesthetic injection) and CPT 29893 (endoscopic plantar fasciotomy), while explicitly excluding dozens of procedures ranging from PRP injections (CPT 0232T, HCPCS P9020) to extracorporeal shock wave therapy (CPT 28890) to acupuncture (CPT 97810–97814). If your practice bills Aetna for any plantar fasciitis treatment beyond the two covered codes, this policy affects your reimbursement and your denial rate.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Plantar Fasciitis Treatments |
| Policy Code | CPB 0235 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Podiatry, orthopedic surgery, physical medicine & rehabilitation, pain management, radiation oncology |
| Key Action | Audit your plantar fasciitis charge capture against the covered codes before billing any Aetna claims after September 26, 2025 |
Aetna Plantar Fasciitis Coverage Criteria and Medical Necessity Requirements 2025
The Aetna plantar fasciitis coverage policy under CPB 0235 is built around a conservative-first framework. Aetna covers two procedures — and the medical necessity bar for each is specific.
CPT 20550 — Injection(s), single tendon sheath or ligament, aponeurosis (plantar fascia)
Aetna considers a combined steroid and anesthetic injection medically necessary when conservative treatments have failed. Conservative treatment means stretching exercises, over-the-counter silicone heel shoe inserts, and two to three weeks of NSAIDs. All three must have been tried. If your documentation doesn't show a failed conservative trial, Aetna will deny CPT 20550.
This is a low bar in clinical terms but a documentation-heavy requirement in billing terms. "Patient tried stretching" in a progress note does not cut it. You need dated documentation of each conservative modality, a documented failure, and then the injection decision. Your physicians should be charting this sequence every time.
CPT 29893 — Endoscopic Plantar Fasciotomy
Aetna considers CPT 29893 medically necessary as an alternative to conventional open plantar fasciotomy. The criteria here are more stringent. The member must have intractable plantar fasciitis or heel spur syndrome, and must have failed a six-month trial of conservative therapy. Six months is the hard threshold. A five-month trial with partial improvement does not qualify.
The policy positions CPT 29893 as an alternative to open fasciotomy — not a first-line surgical option. If your surgeon is jumping to endoscopic fasciotomy without that six-month conservative record, expect a claim denial.
Prior authorization requirements aren't explicitly detailed in CPB 0235 itself, but surgical procedures under Aetna plans routinely trigger prior auth review. Confirm prior authorization requirements for CPT 29893 with the specific Aetna plan before scheduling.
Aetna Plantar Fasciitis Exclusions and Non-Covered Indications
This is where CPB 0235 does the most damage to revenue — and where the list is long.
Aetna treats a wide range of plantar fasciitis treatments as experimental, investigational, or not medically necessary. This isn't a short exclusion list. It covers dozens of codes across injection therapies, energy-based treatments, surgical alternatives, and complementary medicine.
The real issue here is that many of these excluded treatments are actively used in clinical practice and billed regularly. PRP injections (CPT 0232T, HCPCS P9020, Q4139, Q4155) are a common example. Providers see strong clinical interest in PRP for plantar fasciitis. Aetna doesn't cover it. That gap between clinical enthusiasm and payer coverage policy is exactly where denials pile up.
Extracorporeal shock wave therapy (CPT 28890) is excluded. Dry needling (CPT 20560, 20561) is excluded. Acupuncture (CPT 97810 through 97814) is excluded. Low-level laser therapy (HCPCS S8948) is excluded. Botulinum toxin injections (HCPCS J0585, J0586, J0587, J0588) are excluded. Trigger point injections (CPT 20552, 20553) are excluded.
Gastrocnemius recession (CPT 27687), calcaneal osteotomy (CPT 28300), and geniculate artery embolization (CPT 37243) are also in the non-covered group. Radiation treatment delivery codes — CPT 77401 through 77417 and HCPCS G6001 through G6014 — appear in the excluded group as well. Radiation for plantar fasciitis is occasionally explored in academic settings. Aetna does not cover it.
Open fasciotomy variants — CPT 28008, 28060, 28062, and 28250 — are specifically noted as not covered when guided by ultrasonic energy. The ultrasonic guidance restriction is worth flagging to your surgeons directly.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Corticosteroid/anesthetic injection after failed conservative therapy | Covered | CPT 20550 | Requires documented failure of stretching, OTC silicone inserts, and 2–3 weeks of NSAIDs |
| Endoscopic plantar fasciotomy for intractable plantar fasciitis / heel spur syndrome | Covered | CPT 29893 | Requires 6-month failed conservative therapy trial; confirm prior auth |
| PRP injection | Not Covered / Experimental | CPT 0232T, HCPCS P9020, Q4139, Q4155 | Considered experimental/investigational |
| Extracorporeal shock wave therapy | Not Covered | CPT 28890 | Excluded regardless of prior therapy |
| Dry needling | Not Covered | CPT 20560, 20561 | Excluded |
| Acupuncture | Not Covered | CPT 97810, 97811, 97812, 97813, 97814 | Excluded |
| Low-level laser therapy | Not Covered | HCPCS S8948 | Excluded |
| Trigger point injections | Not Covered | CPT 20552, 20553 | Excluded |
| Botulinum toxin injections | Not Covered | HCPCS J0585, J0586, J0587, J0588 | Excluded |
| Gastrocnemius recession | Not Covered | CPT 27687 | Excluded |
| Calcaneal osteotomy | Not Covered | CPT 28300 | Excluded |
| Vascular embolization (geniculate artery) | Not Covered | CPT 37243 | Excluded |
| Radiation treatment delivery | Not Covered | CPT 77401–77417, HCPCS G6001–G6014 | Excluded |
| Open fasciotomy with ultrasonic guidance | Not Covered | CPT 28008, 28060, 28062, 28250 | Specifically excluded when ultrasonic energy is used |
| Low dye strapping/taping | Not Covered | CPT 29540 | Excluded |
| Neurolysis, common plantar nerve | Not Covered | CPT 64640 | Excluded |
| Chemodenervation, extremity | Not Covered | CPT 64642, 64643, 64644, 64645 | Excluded |
| Kinesio taping, ozone injection, TenJet | Not Covered | HCPCS E0761, E0769 | Excluded |
| Autologous white blood cell concentrate injection | Not Covered / Experimental | CPT 0481T | Experimental/investigational |
| Autologous protein solution injection | Not Covered / Experimental | CPT 0481T | Experimental/investigational |
Aetna Plantar Fasciitis Billing Guidelines and Action Items 2025
The effective date is September 26, 2025. Here's what to do before and after that date.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for all plantar fasciitis CPT codes before September 26, 2025. Pull claims billed in the last 90 days. Identify any codes in the excluded group — especially PRP (CPT 0232T), ESWT (CPT 28890), dry needling (CPT 20560/20561), and acupuncture (CPT 97810–97814). These will deny under CPB 0235. If your team has been getting away with some of these under older policy language, that gap closes on the effective date. |
| 2 | Build documentation templates for CPT 20550 that capture all three conservative therapy elements. The policy requires documented failure of stretching exercises, OTC silicone heel inserts, and NSAIDs (two to three weeks minimum). Your EHR template for plantar fasciitis should prompt documentation of each. A generic "conservative treatment failed" note is not enough to defend medical necessity on audit. |
| 3 | Apply the six-month rule strictly to CPT 29893 authorization requests. Before submitting prior authorization for endoscopic plantar fasciotomy, confirm the chart shows six full months of conservative therapy with documented failure. Date-stamp every conservative treatment visit. Aetna will look for this in the prior auth review. |
| 4 | Flag PRP plantar fasciitis billing immediately. If your podiatry or orthopedic group bills PRP injections (CPT 0232T, HCPCS P9020) for plantar fasciitis to Aetna, stop. This will deny. It's categorized as experimental/investigational under CPB 0235. Have that conversation with your clinical team before September 26, 2025. |
| 5 | Review open fasciotomy surgical coding for ultrasonic guidance. CPT 28008, 28060, 28062, and 28250 are all excluded specifically when guided by ultrasonic energy. If your surgeons use ultrasound guidance for any of these procedures, the claim will be denied. Confirm your operative report documentation and modifier usage before billing. |
| 6 | Confirm plan-level prior authorization requirements for CPT 29893. CPB 0235 sets the medical necessity criteria, but individual Aetna plan documents control prior auth triggers. Surgical procedures in particular tend to require prior authorization across most Aetna commercial and Medicare Advantage plans. Don't assume the policy document is the whole picture. Check the specific plan. |
| 7 | Educate your billing team on the excluded code list. The volume of excluded codes in CPB 0235 is substantial. Your plantar fasciitis billing guidelines should include a quick-reference list of the non-covered codes so your charge entry team doesn't inadvertently submit them against Aetna plans. |
If you're seeing a high volume of plantar fasciitis claims with treatment modalities in the excluded group, talk to your compliance officer before the September 26, 2025 effective date. Retroactive denial exposure on PRP and ESWT claims is real.
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Plantar Fasciitis Under CPB 0235
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 20550 | CPT | Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia") |
| 29893 | CPT | Endoscopic plantar fasciotomy |
Not Covered / Experimental CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0232T | CPT | Injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation | Experimental/investigational |
| 0481T | CPT | Injection(s), autologous white blood cell concentrate (autologous protein solution), any site | Experimental/investigational |
| 20552 | CPT | Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) | Not covered |
| 20553 | CPT | Injection(s); single or multiple trigger point(s), 3 or more muscle(s) | Not covered |
| 20560 | CPT | Needle insertion(s) without injection(s); 1 or 2 muscle(s) [dry needling] | Not covered |
| 20561 | CPT | Needle insertion(s) without injection(s); 3 or more muscles [dry needling] | Not covered |
| 27687 | CPT | Gastrocnemius recession (e.g., Strayer procedure) | Not covered |
| 28300 | CPT | Osteotomy; calcaneus (e.g., Dwyer or Chambers type procedure), with or without internal fixation | Not covered |
| 28890 | CPT | Extracorporeal shock wave, high energy, performed by a physician or other qualified healthcare professional | Not covered |
| 29540 | CPT | Strapping; ankle and/or foot [low dye strapping/taping] | Not covered |
| 37243 | CPT | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation | Not covered |
| 64640 | CPT | Destruction by neurolytic agent; other peripheral nerve or branch [neurolysis of the common plantar nerve] | Not covered |
| 64642 | CPT | Chemodenervation of one extremity | Not covered |
| 64643 | CPT | Chemodenervation of one extremity | Not covered |
| 64644 | CPT | Chemodenervation of one extremity | Not covered |
| 64645 | CPT | Chemodenervation of one extremity | Not covered |
| 76937 | CPT | Ultrasound guidance for vascular access | Not covered |
| 77401 | CPT | Radiation treatment delivery | Not covered |
| 77402 | CPT | Radiation treatment delivery | Not covered |
| 77403 | CPT | Radiation treatment delivery | Not covered |
| 77404 | CPT | Radiation treatment delivery | Not covered |
| 77405 | CPT | Radiation treatment delivery | Not covered |
| 77406 | CPT | Radiation treatment delivery | Not covered |
| 77407 | CPT | Radiation treatment delivery | Not covered |
| 77408 | CPT | Radiation treatment delivery | Not covered |
| 77409 | CPT | Radiation treatment delivery | Not covered |
| 77410 | CPT | Radiation treatment delivery | Not covered |
| 77411 | CPT | Radiation treatment delivery | Not covered |
| 77412 | CPT | Radiation treatment delivery | Not covered |
| 77413 | CPT | Radiation treatment delivery | Not covered |
| 77414 | CPT | Radiation treatment delivery | Not covered |
| 77415 | CPT | Radiation treatment delivery | Not covered |
| 77416 | CPT | Radiation treatment delivery | Not covered |
| 77417 | CPT | Radiation treatment delivery | Not covered |
| 97035 | CPT | Application of a modality to 1 or more areas; ultrasound, each 15 minutes | Not covered |
| 97810 | CPT | Acupuncture without/with electrical stimulation | Not covered |
| 97811 | CPT | Acupuncture without/with electrical stimulation | Not covered |
| 97812 | CPT | Acupuncture without/with electrical stimulation | Not covered |
| 97813 | CPT | Acupuncture without/with electrical stimulation | Not covered |
| 97814 | CPT | Acupuncture without/with electrical stimulation | Not covered |
| 28008 | CPT | Fasciotomy, foot and/or toe | Not covered when guided by ultrasonic energy |
| 28060 | CPT | Fasciectomy, plantar fascia; partial (separate procedure) | Not covered when guided by ultrasonic energy |
| 28062 | CPT | Fasciectomy, plantar fascia; radical (separate procedure) | Not covered when guided by ultrasonic energy |
| 28250 | CPT | Division of plantar fascia and muscle (e.g., Steindler stripping) (separate procedure) | Not covered when guided by ultrasonic energy |
Not Covered / Experimental HCPCS Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| E0761 | HCPCS | Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device | Not covered |
| E0769 | HCPCS | Electrical stimulation or electromagnetic wound treatment device, not otherwise classified | Not covered |
| G6001 | HCPCS | Radiation treatment delivery | Not covered |
| G6002 | HCPCS | Radiation treatment delivery | Not covered |
| G6003 | HCPCS | Radiation treatment delivery | Not covered |
| G6004 | HCPCS | Radiation treatment delivery | Not covered |
| G6005 | HCPCS | Radiation treatment delivery | Not covered |
| G6006 | HCPCS | Radiation treatment delivery | Not covered |
| G6007 | HCPCS | Radiation treatment delivery | Not covered |
| G6008 | HCPCS | Radiation treatment delivery | Not covered |
| G6009 | HCPCS | Radiation treatment delivery | Not covered |
| G6010 | HCPCS | Radiation treatment delivery | Not covered |
| G6011 | HCPCS | Radiation treatment delivery | Not covered |
| G6012 | HCPCS | Radiation treatment delivery | Not covered |
| G6013 | HCPCS | Radiation treatment delivery | Not covered |
| G6014 | HCPCS | Radiation treatment delivery | Not covered |
| J0585 | HCPCS | Injection, onabotulinumtoxin A, 1 unit | Not covered |
| J0586 | HCPCS | Injection, abobotulinumtoxin A, 5 units | Not covered |
| J0587 | HCPCS | Injection, rimabotulinumtoxin B, 100 units | Not covered |
| J0588 | HCPCS | Injection, incobotulinumtoxin A, 1 unit | Not covered |
| J0666 | HCPCS | Injection, bupivacaine liposome, 1 mg | Not covered |
| J1030 | HCPCS | Injection, methylprednisolone acetate, 40 mg | Not covered |
| J2001 | HCPCS | Injection, lidocaine HCl for intravenous infusion, 10 mg | Not covered |
| P9020 | HCPCS | Platelet rich plasma, each unit | Not covered / experimental |
| Q4139 | HCPCS | Amniomatrix or biodmatrix, injectable, 1 cc | Not covered / experimental |
| Q4155 | HCPCS | Neoxflo or clarixflo, 1 mg | Not covered / experimental |
| S8948 | HCPCS | Application of modality (requiring constant provider attendance); low-level laser therapy | Not covered |
| A4570 | HCPCS | Splint | Related code |
| L3000 | HCPCS | Foot insert, removable, molded to patient model, UCB type, custom fabricated | Related code |
| L3001 | HCPCS | Foot insert, removable, molded to patient model, spenco, custom fabricated | Related code |
| L3002 | HCPCS | Foot insert, removable, molded to patient model, plastazone or equal, custom fabricated | Related code |
| L3003 | HCPCS | Foot insert, removable, molded to patient model, silicone gel, custom fabricated | Related code |
| L3004 | HCPCS | Foot insert, removable, molded to patient model, plastazote or equal, custom fabricated | Related code |
| L3005 | HCPCS | Foot insert, removable, molded to patient model, dropped metatarsal pad, custom fabricated | Related code |
Key ICD-10-CM Diagnosis Codes
The policy data does not list specific ICD-10-CM codes for CPB 0235. Your claims should use the appropriate plantar fasciitis diagnosis codes (M72.2 — Plantar fascial fibromatosis is the most common) to support medical necessity, but Aetna has not published a specific ICD-10 code list within this coverage policy.
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