Aetna modified CPB 0297 covering cryoanalgesia and therapeutic cold, effective February 25, 2026. Here's what billing teams need to know before submitting claims.
Aetna, a CVS Health company, updated Clinical Policy Bulletin 0297 to clarify which cryoanalgesia and therapeutic cold applications it covers — and which it considers experimental or unproven. The policy draws hard lines between passive cold compression devices (covered as DME) and active mechanical cold units (not covered), and it addresses cryoneurolysis indications across a wide range of procedures. If your practice bills CPT 64600, 64620, or HCPCS codes like C9808, C9809, or C9817, this update directly affects your reimbursement and claim denial risk.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Cryoanalgesia and Therapeutic Cold |
| Policy Code | CPB 0297 |
| Change Type | Modified |
| Effective Date | February 25, 2026 |
| Impact Level | High |
| Specialties Affected | Pain Management, Orthopedics, Thoracic Surgery, Cardiac Surgery, Oncology, DME Suppliers, Neurology |
| Key Action | Audit charge capture for active cold units (C9810, C9817, E0218) and confirm passive-only DME is billed for non-surgical indications before submitting claims |
Aetna Cryoanalgesia and Therapeutic Cold Coverage Criteria and Medical Necessity Requirements 2026
The CPB 0297 Aetna coverage policy defines medical necessity narrowly. There are four covered categories — and everything else is presumed experimental or unproven.
Chronic refractory trigeminal neuralgia is covered for cryoanalgesia when the patient meets selection criteria listed in the CPB appendix. Bill with CPT 64600 (destruction by neurolytic agent, trigeminal nerve — supraorbital, infraorbital, mental, or inferior alveolar branch). Medical necessity documentation must reflect that the neuralgia is chronic and refractory — failed conservative treatment is implied by "refractory," so document it explicitly.
Nuss and Ravitch procedures are the other surgical indications that clear the medical necessity bar. Aetna covers pre-operative, intra-operative, and post-operative cryoanalgesia for post-operative pain management tied to these pectus repair procedures. CPT 21740–21743 covers the reconstructive repair itself. CPT 64420 (intercostal nerve, single) and 64421 (intercostal nerves, multiple, regional block) are the anesthesia-adjacent codes most likely to appear alongside cryoanalgesia billing here.
Passive cold compression therapy units qualify as covered durable medical equipment. The policy names Aircast Cryo/Cuff products, the Polar Care Cub, and Polar Care Packs as examples. These devices get reimbursement as DME for controlling swelling, edema, hematoma, hemarthrosis, and pain. HCPCS A9273 (hot water bottle, ice cap or collar, heat and/or cold wrap, any type) is the relevant code for passive cold wraps.
Passive hot and cold therapy is covered in a general sense. Aetna explicitly states that mechanical circulating units with pumps have not been proven more effective than passive therapy. That language is doing legal work — it's Aetna's justification for denying active pump units. Keep it in mind when a patient or physician pushes back on a denial.
Prior authorization requirements are not explicitly enumerated in this policy bulletin, but given the surgical context of the covered indications and the DME designation, check Aetna's authorization guidelines for CPT 64600 and 64620 separately. DME claims for passive cold compression should follow standard DME prior auth pathways. If you're unsure how prior authorization applies to your patient mix, loop in your billing consultant before the February 25, 2026 effective date.
Aetna Cryoanalgesia and Therapeutic Cold Exclusions and Non-Covered Indications
This is where CPB 0297 does the most damage to revenue if your team isn't aligned. The exclusion list is long, specific, and includes products many practices already have in use.
Active cold units with mechanical pumps are experimental across the board. That means AutoChill, BioCryo Cold Compression System, Breg Polar Care Cube, Game Ready control units, DonJoy IceMan products, Ossur Cold Rush, Hilotherm devices, and VPULSE are all non-covered. HCPCS C9817 (Game Ready GRPro 2.1 system), C9810 (water circulating motorized cold therapy device, e.g., IceMan), E0218 (water circulating cold pad with pump), and E0217 (water circulating heat pad with pump) all fall under this exclusion.
The policy makes one clarification worth flagging: Aetna denies active cold compression units even when they're prescribed only for the compression component, not the cold. If a physician orders the Game Ready system for compression alone, that claim still gets denied. Don't let a prescriber's intent override the equipment category.
Devices combining hot and cold therapy are also excluded. The list includes Aqua Relief System, Waegener cTreatment, NanoTherm, ProThermo PT-9, Thermacure Contrast Compression Therapy, Kinex ThermoComp, VascuTherm 4, VascuTherm 5, Recovery+ Thermal Compression System, and Thermo Plus-System. These are denied for reducing pain and swelling after surgery or injury, and for all other indications.
Cryoanalgesia after sternotomy — including open-heart surgery, open mitral valve replacement, and thoraco-abdominal aortic aneurysm repair — is experimental. CPT codes 33016–33999 cover surgical procedures on the heart and pericardium; cryoanalgesia billed alongside those codes will not pass medical necessity review under this policy.
Post-thoracotomy and post-tonsillectomy cryoanalgesia are both excluded. CPT 64620 (destruction by neurolytic agent, intercostal nerve) may seem like the right code for intercostal cryoanalgesia post-thoracotomy — but Aetna won't cover it for that indication.
Pre-operative cryoneurolysis for total knee arthroplasty (CPT 27447, 27486, 27487) is experimental. This one surprises practices doing high knee replacement volume. The iovera system, billed under HCPCS C9809, targets this exact indication — and Aetna considers it unproven. Expect denials.
Cryoneurolysis for the following conditions is not covered: abdominal pain from pancreatic cancer (ICD-10 C25.0–C25.9), acute pain, cervicogenic headache (G44.89), chronic head pain from occipital neuralgia, peripheral neuropathic pain, phantom limb pain (G54.6), and post-herpetic neuralgia (B02.21–B02.29).
Other non-covered applications include:
| # | Excluded Procedure |
|---|---|
| 1 | Bedside percutaneous cryoneurolysis for acute rib fracture pain |
| 2 | Cooral intraoral cooling system (CPT 0881T) for oral mucositis prevention during head and neck radiation |
| 3 | Submucosal cryolysis therapy (CPT 0978T, 0979T, 0980T) |
| 4 | Prophylactic hypothermia for traumatic brain injury |
| 5 | Therapeutic hypothermia for cardiogenic shock or hemorrhagic stroke |
| 6 | Therapeutic induction of intra-brain hypothermia (CPT 0776T, e.g., pro2cool) for concussion management |
| 7 | Ultrasound-guided percutaneous intercostal cryoanalgesia after mastectomy (CPT 19301–19307; category III codes 0440T, 0441T, 0442T) |
| 8 | Passive cold compression therapy units for any indication not listed as covered |
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Cryoanalgesia for chronic refractory trigeminal neuralgia | Covered | CPT 64600 | Must meet appendix selection criteria |
| Pre/intra/post-operative cryoanalgesia for Nuss or Ravitch procedure | Covered | CPT 21740–21743, 64420, 64421 | Post-op pain management only |
| Passive cold compression DME (Aircast, Polar Care Cub, Polar Care Packs) | Covered | HCPCS A9273 | Swelling, edema, hematoma, hemarthrosis, pain |
| Passive hot and cold therapy | Covered | HCPCS A9273 | Pumped/circulating units not covered |
| Active cold units with mechanical pumps (Game Ready, IceMan, Breg Polar Care Cube, etc.) | Not Covered | HCPCS C9810, C9817, E0218, E0236 | Experimental even if prescribed for compression only |
| Combination hot/cold therapy devices (VascuTherm, NanoTherm, etc.) | Not Covered | HCPCS E0217, E0249 | All surgical and injury indications excluded |
| Cryoanalgesia after sternotomy (open heart, MVR, thoracoabdominal aortic repair) | Not Covered | CPT 33016–33999 | Experimental |
| Post-thoracotomy and post-tonsillectomy cryoanalgesia | Not Covered | CPT 64620 | Experimental |
| Pre-operative cryoneurolysis for total knee arthroplasty | Not Covered | CPT 27447, 27486, 27487; HCPCS C9809 | iovera system denied |
| Cryoneurolysis for pancreatic cancer pain, phantom limb, post-herpetic neuralgia, PHN | Not Covered | CPT 64640; ICD-10 C25.x, G54.6, B02.2x | Multiple non-covered ICD-10 diagnoses |
| Bedside percutaneous cryoneurolysis for acute rib fracture pain | Not Covered | CPT 64620, HCPCS C9808 | Experimental |
| Cooral intraoral cooling for oral mucositis (head/neck radiation) | Not Covered | CPT 0881T | BrainCool Cooral system denied |
| Submucosal cryolysis therapy | Not Covered | CPT 0978T, 0979T, 0980T | All sites excluded |
| Prophylactic hypothermia for traumatic brain injury | Not Covered | — | No specific code coverage |
| Therapeutic hypothermia for cardiogenic shock | Not Covered | — | Experimental |
| Therapeutic hypothermia for hemorrhagic stroke | Not Covered | — | Experimental |
| Intra-brain hypothermia for concussion (pro2cool) | Not Covered | CPT 0776T | Experimental |
| Ultrasound-guided intercostal cryoanalgesia after mastectomy | Not Covered | CPT 19301–19307; 0440T, 0441T, 0442T | Experimental |
| Passive cold compression for all other indications | Not Covered | HCPCS A9273 | Covered only for listed indications |
Aetna Cryoanalgesia Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your active cold unit inventory before February 25, 2026. If your practice or DME supplier provides Game Ready systems (C9817), DonJoy IceMan units (C9810), or Breg Polar Care Cubes, those claims will be denied for Aetna members regardless of diagnosis. Pull any open Aetna prior authorization requests tied to these devices and reassess. |
| 2 | Remove active cold units from your standard post-op order sets for Aetna members. If your orthopedic or thoracic surgery team has a default order for active cold compression after knee replacement or thoracotomy, flag it for your medical director now. The coverage policy doesn't carve out exceptions for physician preference. |
| 3 | Update charge capture for cryoneurolysis before knee arthroplasty. Pre-operative iovera system use (C9809) paired with CPT 27447, 27486, or 27487 will not pass Aetna medical necessity review. If your anesthesia or pain team performs this routinely, they need to know before the effective date of February 25, 2026. |
| 4 | Verify ICD-10 coding aligns with covered indications before billing CPT 64600 or 64620. Trigeminal neuralgia (G50.0) paired with CPT 64600 is covered when the patient meets appendix criteria. Intercostal nerve destruction (CPT 64620) is covered for Nuss/Ravitch procedures only — not for rib fracture pain, post-thoracotomy pain, or mastectomy-related intercostal analgesia. A mismatched diagnosis code is a fast path to a claim denial. |
| 5 | Educate DME staff on the passive vs. active distinction. The line between covered and non-covered cold therapy equipment runs directly through pump mechanism and refrigeration. Passive units like Polar Care Packs are covered DME. Motorized, refrigerated, or pump-driven units are experimental. If your DME team isn't clear on which HCPCS codes fall where, walk through the C9810, E0218, and A9273 distinctions explicitly. |
| 6 | Check your combination hot/cold therapy device billing. VascuTherm 4 (and 5), NanoTherm, and similar dual-modality devices are all excluded under this CPB. If you've been billing E0217 or E0249 for these units under Aetna, expect recoupment risk. Cryoanalgesia billing for these devices should stop immediately. |
| 7 | If you're treating head and neck cancer patients with the BrainCool Cooral system or considering pro2cool for concussion management, understand that CPT 0881T and 0776T are both non-covered under this policy. Talk to your compliance officer before billing Aetna members for these services. The financial exposure per case 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 Cryoanalgesia and Therapeutic Cold Under CPB 0297
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 64600 | CPT | Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch |
| 64620 | CPT | Destruction by neurolytic agent, intercostal nerve |
Not Covered / Experimental CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0440T | CPT | Ablation, percutaneous, cryoablation; upper extremity distal/peripheral nerve | Experimental — no specific covered indication |
| 0441T | CPT | Ablation, percutaneous, cryoablation; lower extremity distal/peripheral nerve | Experimental — no specific covered indication |
| 0442T | CPT | Ablation, percutaneous, cryoablation; nerve plexus or other truncal nerve | Experimental — no specific covered indication |
| 0776T | CPT | Therapeutic induction of intra-brain hypothermia, including placement of mechanical temperature-control device | Experimental — concussion management |
| 0881T | CPT | Cryotherapy of oral cavity using temperature regulated fluid cooling system | Experimental — oral mucositis prevention |
| 0978T | CPT | Submucosal cryolysis therapy; soft palate, base of tongue, and lingual tonsil | Experimental |
| 0979T | CPT | Submucosal cryolysis therapy; soft palate only | Experimental |
| 0980T | CPT | Submucosal cryolysis therapy; base of tongue and lingual tonsil only | Experimental |
| 64605 | CPT | Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale | Experimental — no covered indication under this CPB |
| 64640 | CPT | Destruction by neurolytic agent; other peripheral nerve or branch | Experimental |
HCPCS Codes — Covered
| Code | Type | Description |
|---|---|---|
| A9273 | HCPCS | Hot water bottle, ice cap or collar, heat and/or cold wrap, any type (passive cold compression) |
HCPCS Codes — Not Covered / Experimental
| Code | Type | Description | Reason |
|---|---|---|---|
| C9808 | HCPCS | Nerve cryoablation probe (e.g., CryoICE, CryoSphere, CryoSphere Max) | Experimental |
| C9809 | HCPCS | Cryoablation needle (e.g., iovera system), including all disposable system components | Experimental — pre-op TKA cryoneurolysis |
| C9810 | HCPCS | Water circulating motorized cold therapy device (e.g., IceMan), including all system components | Experimental — active mechanical pump unit |
| C9817 | HCPCS | Electronic cryo-pneumatic compression pain management system (e.g., Game Ready GRPro 2.1) | Experimental — active cold with compression |
| E0217 | HCPCS | Water circulating heat pad with pump | Experimental — active pump/heat unit |
| E0218 | HCPCS | Water circulating cold pad with pump | Experimental — active pump unit |
| E0236 | HCPCS | Pump for water circulating pad | Experimental |
| E0249 | HCPCS | Pad for water circulating heat unit | Experimental — active pump/heat unit |
| E0650 | HCPCS | Pneumatic compressor; non-segmental home model | Not covered for indications under this CPB |
| E0651 | HCPCS | Pneumatic compressor, segmental home model without calibrated gradient pressure | Not covered for indications under this CPB |
| E0652 | HCPCS | Pneumatic compressor, segmental home model with calibrated gradient pressure | Not covered for indications under this CPB |
| E0660 | HCPCS | Non-segmental pneumatic appliance; full leg | Not covered for indications under this CPB |
| E0666 | HCPCS | Non-segmental pneumatic appliance; half leg | Not covered for indications under this CPB |
| E0667 | HCPCS | Segmental pneumatic appliance; full leg | Not covered for indications under this CPB |
| E0669 | HCPCS | Segmental pneumatic appliance; half leg | Not covered for indications under this CPB |
| E0671 | HCPCS | Segmental gradient pressure pneumatic appliance; full leg | Not covered for indications under this CPB |
| E0673 | HCPCS | Segmental gradient pressure pneumatic appliance; half leg | Not covered for indications under this CPB |
| E0676 | HCPCS | Intermittent limb compression device, not otherwise specified | Not covered for indications under this CPB |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| G50.0 | Trigeminal neuralgia (covered for cryoanalgesia when criteria met) |
| B02.21–B02.29 | Zoster with other nervous system involvement (not covered for cryoneurolysis) |
| C25.0–C25.9 | Malignant neoplasm of pancreas (not covered for abdominal pain cryoneurolysis) |
| C50.011–C50.929 | Malignant neoplasm of breast (mastectomy context — intercostal cryoanalgesia not covered) |
| C79.81 | Secondary malignant neoplasm of breast |
| G44.89 | Other headache syndrome (cervicogenic headache — not covered) |
| G54.6 | Phantom limb syndrome with pain (not covered for cryoneurolysis) |
| G89.0, G89.1, G89.10–G89.14 | Acute pain and central pain syndrome (not covered for post-tonsillectomy or other indications) |
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