Peripheral Atherectomy and Thrombectomy Devices — CPB 0295 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0295 governing peripheral atherectomy and thrombectomy device coverage, effective February 27, 2026. Here's what billing teams need to act on now.

The updated Aetna peripheral atherectomy coverage policy designates the BYCROSS atherectomy device and several intravascular shockwave lithotripsy indications as experimental, and routes all medical necessity determinations for peripheral atherectomy through eviCore Healthcare guidelines. CPT codes 0234T, 0235T, 0236T, and 0237T remain non-covered for specific vessel indications. If your practice bills for peripheral vascular interventions, this change directly affects your prior authorization workflow and claim denial risk.

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Quick-Reference: Aetna CPB 0295 Peripheral Atherectomy Policy Change 2026

Field	Detail
Payer	Aetna, a CVS Health company
Policy	Peripheral Atherectomy and Thrombectomy Devices
Policy Code	CPB 0295
Change Type	Modified
Effective Date	February 27, 2026
Impact Level	High
Specialties Affected	Interventional Radiology, Vascular Surgery, Interventional Cardiology, Cardiovascular Medicine
Key Action	Audit your peripheral atherectomy and shockwave lithotripsy claims against the updated eviCore guidelines and experimental exclusion list before billing against Aetna plans.

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Aetna Peripheral Atherectomy Coverage Criteria and Medical Necessity Requirements 2026

The first thing your billing team needs to understand about this coverage policy update: Aetna does not publish its own medical necessity criteria for peripheral atherectomy within CPB 0295 itself. Instead, it defers entirely to eviCore Healthcare's Peripheral Vascular Intervention Clinical Guidelines.

That's a critical detail. If your team is still checking CPB 0295 for specific clinical thresholds — ankle-brachial index cutoffs, lesion length limits, claudication severity — you won't find them there. You need to pull the eviCore guidelines directly. The version referenced in this policy is V1.1.2023, effective September 1, 2023.

Here's the catch with the eviCore guidelines: they undergo formal annual review, but eviCore reserves the right to change them without prior notice. Draft updates get posted 90 days before implementation, but that's not a guarantee you'll catch every revision in time. Set a calendar reminder to check the eviCore portal quarterly, not just annually.

Medical necessity criteria for peripheral atherectomy are governed by eviCore Peripheral Vascular Intervention Clinical Guidelines, per CPB 0295. Consult your eviCore and Aetna contracts to confirm PA submission requirements.

The revascularization codes in the 37220–37299 range — covering endovascular intervention across iliac, femoral, popliteal, tibial, and peroneal territories — fall under drug-coated balloon angioplasty in Aetna's code grouping for this policy. There is no specific CPT code for drug-coated balloon angioplasty. Your team bills the underlying revascularization CPT with documentation supporting the specific technique used.

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Aetna Peripheral Atherectomy and Thrombectomy Exclusions and Non-Covered Indications

As of February 27, 2026, CPB 0295 designates the following as experimental, investigational, or unproven:

BYCROSS Atherectomy Device

The BYCROSS atherectomy device is explicitly named as experimental for the treatment of peripheral arterial disease (PAD). If any of your physicians have started using this device, stop billing Aetna for it. Claims will deny. The policy cites inadequate clinical evidence — this isn't a coverage-with-conditions situation, it's a flat exclusion.

Intravascular Shockwave Lithotripsy — Excluded Indications

Aetna calls out intravascular shockwave lithotripsy as experimental for calcified peripheral arterial lesions, atherosclerosis, and intermittent claudication across a specific set of arteries:

On top of that, shockwave lithotripsy for celiac artery occlusion and renal artery stenosis is also excluded.

This matters because intravascular shockwave lithotripsy has been growing in adoption at many vascular centers. The technology is FDA-cleared and gaining traction in the cath lab. But Aetna's position is that the peer-reviewed evidence doesn't support routine coverage — and your Aetna claims will reflect that.

Atherectomy of Specific Vessel Territories

Mechanical or laser peripheral atherectomy remains non-covered for the renal artery, visceral artery, abdominal aorta (CPT 0236T), and brachiocephalic trunk and branches (CPT 0237T). CPT 0235T is non-covered for visceral artery indications (except renal). CPT 0234T — the base transluminal peripheral atherectomy code — is non-covered for the indications listed in the policy.

Trellis Peripheral Infusion System

Isolated segmental pharmaco-mechanical thrombolysis using the Trellis Peripheral Infusion System remains experimental. This applies to deep venous thrombosis treatment, Paget-Schroetter syndrome (venous thoracic outlet syndrome), and other indications. The policy cites inadequate peer-reviewed evidence.

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Coverage Indications at a Glance

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Aetna Peripheral Atherectomy Billing Guidelines and Action Items 2026

The effective date of February 27, 2026 means this policy is already active. If you haven't audited your charge capture and PA workflows yet, do it now.

Copy Action Items

If your practice does high volume in peripheral vascular intervention — particularly if you've recently added shockwave lithotripsy to your service line — loop in your compliance officer before your next Aetna claim submission. The experimental designations in this update create real claim denial exposure.

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CPT, HCPCS, and ICD-10 Codes for Peripheral Atherectomy and Thrombectomy Under CPB 0295

Not Covered / Experimental CPT Codes

These codes are explicitly non-covered for the indications listed in CPB 0295:

Drug-Coated Balloon Angioplasty — No Specific CPT Code (Bill Underlying Revascularization Code)

Aetna groups all of the following revascularization codes under drug-coated balloon angioplasty in CPB 0295. There is no dedicated CPT code for drug-coated balloon angioplasty. Bill the appropriate revascularization CPT based on vessel territory and technique:

Other CPT Codes Related to CPB 0295

Code	Type	Description Copy
32096	CPT	Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s), unilateral
35511	CPT	Bypass graft, with vein; subclavian-subclavian

CPB 0295 references 26 additional related CPT codes not fully detailed in this policy summary. Pull the full policy at app.payerpolicy.org/p/aetna/0295 for the complete list.

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