Upper Limb Prostheses — CPB 0399 | AETNA Coverage Update

Aetna modified CPB 0399 governing upper limb prostheses coverage, effective February 14, 2026. Here's what billing teams need to know now.

Aetna, a CVS Health company, updated Clinical Policy Bulletin 0399 covering upper limb prostheses — including myoelectric hands, body-powered devices, and functional finger prostheses. This Aetna upper limb prostheses coverage policy touches a wide range of HCPCS codes for prosthetic devices and CPT codes in the 24900s, 25900s, and 26900s (and additional codes) for upper extremity amputation surgery. If your practice or DME supplier handles prosthetics billing for Aetna members, this update has direct financial exposure.

Quick-Reference Table

Aetna Upper Limb Prostheses Coverage Criteria and Medical Necessity Requirements 2026

The real issue with CPB 0399 Aetna is the layered medical necessity structure. Meeting one or two criteria is not enough. Aetna requires all seven general conditions to be satisfied before it considers any orthosis or prosthesis medically necessary.

Here's what the updated coverage policy requires across the board:

That six-month window is a common claim denial trigger. If your workflow has any lag between prescription and fitting — common in complex upper limb cases — you need a process to track that date actively.

For myoelectric upper limb prostheses specifically, the coverage policy adds four more criteria on top of the general seven. Devices like the i-LIMB, Ottobock bebionic hand, OttoBock System Electrohand, Utah Elbow System, Dynamic Mode Control hand, LTI Boston Digital Arm System, and Liberty Mutual Boston Elbow are only covered when:

That third criterion is the one that generates the most friction. Aetna positions myoelectric devices as second-line. Your clinical documentation must explicitly address why a body-powered device is insufficient. If it doesn't, expect a denial.

CPB 0399 does not specify uniform prior authorization requirements. PA requirements vary by Aetna plan. Always verify PA requirements through the member's specific plan benefits before submitting — this is not a policy where you can assume a blanket rule applies. If you're unsure, call Aetna provider services before submitting the claim.

Aetna Upper Limb Prostheses Exclusions and Non-Covered Indications

The source data for CPB 0399 is extensive, and the full policy contains additional exclusions and non-covered indications beyond what is summarized here. Before making claims decisions based on any exclusion, verify the complete policy text directly at PayerPolicy CPB 0399 or through Aetna's provider portal. What follows reflects the full CPB 0399 policy text — but given the policy's length and complexity, your billing team should work from the complete document.

Microprocessor-controlled prosthetic arms (multi-articulating hands) and osseointegrated upper limb prostheses are considered experimental and investigational per the full policy. Aetna considers the clinical evidence insufficient to support routine coverage.

Targeted muscle reinnervation (TMR) as a standalone procedure for upper limb prosthetics is also non-covered under this policy. If your surgeons perform TMR in conjunction with amputation or revision, document the clinical rationale carefully — and don't assume bundled or secondary billing will get reimbursement for the TMR component.

Neural interface prosthetics — devices controlled by direct neural signal rather than surface EMG — fall into the same experimental and investigational category. These are emerging technologies, and Aetna's position here is consistent with where most major payers sit in 2026.

The practical takeaway: if a patient's prosthetist is recommending a newer-generation device, verify the specific product against the full policy before ordering. A device a referring physician describes as "myoelectric" may actually fall under the multi-articulating or neural interface exclusion.

Coverage Indications at a Glance

Aetna Upper Limb Prostheses Billing Guidelines and Action Items 2026

The effective date of February 14, 2026 is already here. If your team hasn't reviewed your documentation templates and charge capture workflows, do it now.

CPT, HCPCS, and ICD-10 Codes for Upper Limb Prostheses Under CPB 0399

The policy data for CPB 0399 includes 111 CPT codes, 77 HCPCS codes, and 16 ICD-10-CM codes. The CPT codes below represent the surgical amputation codes that feed into the prosthetics billing pathway — they establish the clinical context for downstream prosthetic device claims.

Covered CPT Codes — Upper Extremity Amputation (When Selection Criteria Are Met)

The policy data references 31 additional CPT codes not fully listed in the provided data. The policy also includes 77 HCPCS codes and 16 ICD-10-CM codes. Access the full code set at PayerPolicy CPB 0399.