Gait Analysis and Electrodynogram — CPB 0263 | AETNA Coverage Update

TL;DR: Aetna modified CPB 0263 covering gait analysis and electrodynogram services, effective September 26, 2025. CPT codes 96000, 96001, 96002, 96003, and 96004 are not covered for the indications listed in this policy — and your billing team needs to know before claims go out the door.

Aetna, a CVS Health company, updated this coverage policy under CPB 0263 Aetna system. The change affects comprehensive computer-based motion analysis, dynamic plantar pressure measurement, dynamic surface EMG, dynamic fine wire EMG, and physician review and interpretation — all billed under CPT codes 96000 through 96004. If your practice or facility bills gait analysis for patients with cerebral palsy, paralytic syndromes, or abnormal gait, this policy directly affects your reimbursement exposure.

Quick-Reference Table

Aetna Gait Analysis Coverage Criteria and Medical Necessity Requirements 2025

The Aetna gait analysis coverage policy under CPB 0263 takes a hard line: CPT codes 96000, 96001, 96002, 96003, and 96004 are not covered for the indications listed in this bulletin. That's not ambiguous language — it's a flat non-coverage designation.

This matters because gait analysis codes are frequently billed alongside physical medicine and rehabilitation services, especially for patients with neurological conditions. If your billing team has been submitting 96000 or 96002 for Aetna patients assuming medical necessity documentation would carry the claim, that strategy will produce claim denial under this policy.

The medical necessity bar here isn't a high bar to clear — there is no bar. The policy doesn't say "covered with prior authorization" or "covered with additional documentation." It says not covered. Prior authorization won't rescue these claims if the underlying policy designates the service as non-covered. Don't waste time building PA workflows around codes the policy excludes entirely.

The ICD-10-CM codes listed in this policy — cerebral palsy codes G80.0 through G80.9, paralytic syndromes G82.20 through G83.9, abnormal gait and mobility codes R26.0 through R26.9, and coordination deficit codes R27.0 through R27.9 — represent the patient populations most likely to receive gait analysis services. These are exactly the diagnoses where your team might have assumed coverage would follow medical necessity. Under this updated policy, they don't.

Aetna Gait Analysis Exclusions and Non-Covered Indications

Every CPT code under CPB 0263 falls in the "not covered for indications listed in the CPB" group. That applies across the full spectrum of gait analysis services.

CPT 96000 — comprehensive computer-based motion analysis by video and 3-D kinematics — is not covered. CPT 96001 — the same with dynamic plantar pressure measurements during walking — is not covered. Dynamic surface electromyography (CPT 96002, covering one to 12 muscles during walking or functional activities) is not covered. Dynamic fine wire electromyography (CPT 96003, one muscle) is not covered. And CPT 96004 — physician or qualified health professional review and interpretation of comprehensive motion analysis — is not covered.

The real issue here is scope. This isn't a narrow exclusion for one testing modality. It covers the entire workflow: the motion capture, the pressure measurement, the EMG components, and even the interpretation. There's no piece of a gait analysis encounter that survives this non-coverage designation under Aetna's policy.

This pattern mirrors how Aetna handles other functional diagnostic testing categories — non-coverage applied broadly rather than procedure by procedure. If you've seen their handling of certain neurological monitoring codes, this reads the same way.

Coverage Indications at a Glance

Aetna Gait Analysis Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. That's your hard deadline. Here's what your billing team needs to do before then — and what to do with claims already in the queue.

CPT, HCPCS, and ICD-10 Codes for Gait Analysis Under CPB 0263

Not Covered CPT Codes (All Indications Listed in CPB 0263)

Key ICD-10-CM Diagnosis Codes Referenced in CPB 0263