TL;DR: Aetna, a CVS Health company, modified CPB 0447 governing CRPS/RSD treatment coverage, effective February 25, 2026. Here's what changes for billing teams.
Aetna CPB 0447 covers CRPS (complex regional pain syndrome) and RSD (reflex sympathetic dystrophy) treatments — a policy area where claim denial risk is high because the criteria are layered and treatment-specific. The modified coverage policy touches CPT codes 62324–62327 (epidural catheter placements), 64510 and 64520 (sympathetic nerve blocks), and 63650–63688 (spinal cord stimulator implants and revisions), among 389 total CPT codes in scope. If your practice manages pain patients with Aetna coverage, audit your documentation before billing against this policy.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Complex Regional Pain Syndrome (CRPS) / Reflex Sympathetic Dystrophy (RSD): Treatments |
| Policy Code | CPB 0447 |
| Change Type | Modified |
| Effective Date | February 25, 2026 |
| Impact Level | High |
| Specialties Affected | Pain Management, Anesthesiology, Neurosurgery, Physical Medicine & Rehabilitation, Neurology |
| Key Action | Verify documentation meets all layered selection criteria before submitting claims for epidural analgesia, sympathetic blocks, or spinal cord stimulators under CPB 0447 Aetna |
Aetna CRPS/RSD Treatment Coverage Criteria and Medical Necessity Requirements 2026
The Aetna CRPS/RSD coverage policy is built around three covered interventions — and each one has its own criteria stack. Miss one element of that stack, and you're looking at a denial.
Continuous Epidural Analgesia (CPT 62324–62327, 01996)
Aetna considers continuous epidural analgesia medically necessary only when all three of these conditions are met:
| # | Covered Indication |
|---|---|
| 1 | Pain lasting more than three months despite conservative therapy (exercises, physical modalities, medications) |
| 2 | Failed trial of physical therapy |
| 3 | Failed trial of nerve blocks with local anesthetics and steroids |
All three. Not two of three. Your documentation has to show the full progression. If the member hasn't failed a nerve block trial before the epidural is pursued, Aetna treats the epidural as experimental. That's a denial waiting to happen — and it's one of the cleaner traps in this coverage policy.
Sympathetic Nerve Blocks (CPT 64510, 64520, 64530)
Sympathetic blocks — stellate ganglion (CPT 64510) and lumbar sympathetic (CPT 64520) — are covered for CRPS diagnosis and treatment after three months of failed conservative care, including analgesia and PT. The policy allows up to three injections to diagnose the pain and achieve a therapeutic effect. After three with no relief, additional injections are not considered medically necessary.
Here's where the billing guidelines get specific: repeat blocks beyond the initial three are covered only when they're part of a comprehensive pain management program. That program must include PT, patient education, psychosocial support, and oral medications where appropriate. Document every element of that program — not just the block itself. And note the frequency limit: Aetna will not cover sympathetic blocks billed more often than once every seven days.
Dorsal Column Stimulators (CPT 63650, 63655, 63661–63664, 63685, 63688)
Dorsal column stimulators (DCS) are covered as durable medical equipment (DME) for CRPS management, but Aetna cross-references CPB 0194 (Spinal Cord Stimulation) for the full criteria set. Medical necessity for these codes depends entirely on meeting CPB 0194 criteria — not just CPB 0447. If your team is billing CPT 63650 (percutaneous electrode implantation) or 63685 (pulse generator insertion), pull CPB 0194 and verify the member meets those criteria too. Billing CPT codes for DCS without CPB 0194 compliance documentation is a fast path to a prior authorization failure or post-payment audit finding.
Dorsal root ganglion (DRG) stimulation for CRPS is also directed to CPB 0194. Combined DRG stimulation and dorsal column spinal cord stimulation is a different story — Aetna considers that combination experimental (more on this below).
Aetna CRPS/RSD Exclusions and Non-Covered Indications
This is a long exclusion list, and it's where many billing teams get caught — especially on treatments that have grown in clinical use but haven't cleared Aetna's evidence bar.
IV infusions: Intravenous guanethidine, ketamine (including "ketamine coma" protocols), lidocaine, and midazolam are all experimental for CRPS, other chronic pain conditions, and depression. If your practice has started billing ketamine infusions for CRPS patients on Aetna plans, stop and verify coverage before the next claim goes out.
The long list of experimental treatments covers a wide range. Some of these will surprise clinicians who use them routinely elsewhere:
| # | Excluded Procedure |
|---|---|
| 1 | Bisphosphonates for CRPS |
| 2 | Botulinum toxin injections |
| 3 | Bier block |
| 4 | Interleukin-1 receptor antagonists (anakinra, canakinumab, rilonacept, sarilumab, tocilizumab) |
| 5 | Intrathecal baclofen, clonidine, adenosine, and corticosteroids |
| 6 | Combined transcranial direct current stimulation and transcutaneous electrical nerve stimulation |
| 7 | Electroconvulsive therapy |
| 8 | Hypnosis |
| 9 | Exergame therapy |
| 10 | Free-flap surgery and vein wrapping |
| 11 | BEMER magneto-therapy |
| 12 | Compression sleeve |
| 13 | Amputation for CRPS |
Combined DRG stimulation plus dorsal column SCS is also on the experimental list. This is worth flagging to your clinical team. A provider might see two covered procedures individually and assume the combination is fine. Aetna doesn't see it that way.
Intrapleural analgesia for thoracic dermatome CRPS pain is also experimental. Neurolysis of the spinal accessory nerve is experimental. Neither of these has a path to covered status under the current policy.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Continuous epidural analgesia for intractable CRPS (3+ months, failed PT and nerve blocks) | Covered | 62324, 62325, 62326, 62327, 01996 | All three criteria must be met; experimental if criteria not met |
| Sympathetic blocks (up to 3) for diagnosis and treatment after failed conservative care | Covered | 64510, 64520, 64530 | Three-block limit for initial phase |
| Repeat sympathetic blocks (beyond 3) as part of comprehensive pain program | Covered | 64510, 64520, 64530 | Requires PT, education, psychosocial support, oral meds; max frequency once per 7 days |
| Dorsal column stimulator implantation/revision for CRPS | Covered (as DME) | 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688 | Must meet CPB 0194 criteria; cross-reference required |
| IV ketamine, lidocaine, guanethidine, or midazolam for CRPS | Experimental | — | Not covered; includes "ketamine coma" protocols |
| Combined DRG + dorsal column SCS stimulation | Experimental | — | Each may be covered separately under CPB 0194; combination is not |
| Bisphosphonates for CRPS | Experimental | — | Not covered |
| Botulinum toxin for CRPS | Experimental | — | Not covered |
| Intrathecal baclofen, clonidine, adenosine, or corticosteroids | Experimental | — | None of these intrathecal options are covered for CRPS |
| Interleukin-1 receptor antagonists (anakinra, tocilizumab, etc.) | Experimental | — | Not covered for CRPS |
| Intrapleural analgesia for thoracic CRPS | Experimental | — | Not covered |
| Neurolysis of spinal accessory nerve | Experimental | — | Not covered for CRPS or post-traumatic chronic pain |
| Bier block, BEMER therapy, hypnosis, exergame therapy | Experimental | — | Not covered |
| Amputation for CRPS | Experimental | — | Not covered |
| Electroconvulsive therapy for CRPS | Experimental | — | Not covered |
Aetna CRPS/RSD Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your epidural analgesia claims before billing. For CPT 62324–62327 and 01996, confirm your documentation shows three months of failed conservative care, a failed PT trial, and a failed nerve block trial — in that order. Aetna requires all three. A note that says "failed conservative management" without specifics is not enough to defend a claim. |
| 2 | Track sympathetic block counts per member. Aetna limits the first phase to three injections (CPT 64510, 64520, 64530). Build a tracking mechanism in your EHR or practice management system to flag when a member hits that threshold. Claims for a fourth injection need comprehensive pain program documentation attached — PT, psychosocial support, patient education, and medications. |
| 3 | Enforce the seven-day frequency rule on sympathetic blocks. Billing CPT 64510 or 64520 more than once per week will trigger a denial. Audit your scheduling protocols. If a provider is booking blocks closer than seven days apart for Aetna members, fix that workflow before February 25, 2026. |
| 4 | Pull CPB 0194 before billing DCS codes. For CPT 63650, 63655, 63661–63664, 63685, and 63688, CPB 0447 is not the only policy in play. Aetna explicitly requires CPB 0194 criteria for coverage. Check both policies and document compliance with both before submitting. This is a dual-policy dependency — and it's the kind of thing that gets missed in busy billing shops. |
| 5 | Flag ketamine infusion claims immediately. If your practice bills IV ketamine for CRPS under Aetna plans, that's an experimental designation under this coverage policy. Review open claims and pending submissions now. The effective date of February 25, 2026 is already in effect — don't wait for denials to find this. |
| 6 | Educate your clinical team on the experimental list. Botulinum toxin, bisphosphonates, and combined DRG/SCS stimulation are all in clinical use elsewhere. Aetna doesn't cover them for CRPS. Brief your medical director and relevant providers before patients receive these treatments and expect coverage. |
| 7 | Document the Budapest Criteria. Aetna references the Budapest Criteria for clinical CRPS diagnosis in this policy. Your clinical documentation should reflect those diagnostic criteria — not just a CRPS ICD-10 code. Reviewers look for diagnosis support in the record. |
If your practice does high volume on any of these CRPS treatment codes and you're uncertain how this applies to your payer mix, talk to your compliance officer before March 15, 2026. The layered criteria and dual-policy dependency on CPB 0194 create real audit exposure.
| 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 CRPS/RSD Treatments Under CPB 0447
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 01996 | CPT | Daily hospital management of epidural or subarachnoid continuous drug administration |
| 62324 | CPT | Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic |
| 62325 | CPT | Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus; cervical or thoracic, with imaging guidance (fluoroscopy or CT) |
| 62326 | CPT | Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus; lumbar or sacral |
| 62327 | CPT | Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus; lumbar or sacral, with imaging guidance (fluoroscopy or CT) |
| 63650 | CPT | Percutaneous implantation of neurostimulator electrode array, epidural |
| 63655 | CPT | Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural |
| 63661 | CPT | Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed |
| 63662 | CPT | Removal of spinal neurostimulator electrode plate/paddle(s), placed via laminotomy or laminectomy, including fluoroscopy, when performed |
| 63663 | CPT | Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed |
| 63664 | CPT | Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s), placed via laminotomy or laminectomy, including fluoroscopy, when performed |
| 63685 | CPT | Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling |
| 63688 | CPT | Revision or removal of implanted spinal neurostimulator pulse generator or receiver |
| 64479 | CPT | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level |
| 64480 | CPT | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance; cervical or thoracic, each additional level |
| 64481 | CPT | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance; lumbar or sacral, single level |
| 64482 | CPT | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance; lumbar or sacral, each additional level |
| 64483 | CPT | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance; lumbar or sacral, single level |
| 64484 | CPT | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance; lumbar or sacral, each additional level |
| 64510 | CPT | Injection, anesthetic agent; stellate ganglion (cervical sympathetic) |
| 64520 | CPT | Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) |
| 64530 | CPT | Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring |
Not Covered / Experimental CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 64400 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered for local anesthesia only or non-CRPS indications per CPB 0447 |
| 64401 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64402 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64403 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64404 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64405 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64406 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64407 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64408 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64409 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64410 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64411 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64412 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64413 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64414 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64416 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64417 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64418 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64419 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64420 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64421 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64422 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64423 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64424 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64425 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64426 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64427 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64428 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64429 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64430 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64431 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64432 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64433 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64434 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64435 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64436 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64437 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64438 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64439 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64440 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64441 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64442 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64443 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64444 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64445 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64446 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64447 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64448 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64449 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64450 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64451 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64452 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64453 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64454 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64455 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64490 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64491 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
| 64492 | CPT | Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic | Not covered per CPB 0447 indications |
Note: The full policy includes 389 CPT codes and 125 HCPCS codes. The codes listed above reflect those explicitly detailed in the policy data provided. See the full CPB 0447 policy for the complete code set.
The policy data provided did not include ICD-10-CM code details beyond noting 22 codes in scope. Reference the full policy document for the complete ICD-10-CM list.
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