Peripheral Vascular Rehabilitation Programs — CPB 0458 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0458 covering peripheral vascular rehabilitation programs, effective September 26, 2025. CPT 93668 remains the covered code for supervised PAD rehab sessions. CPT 0631T is explicitly excluded. Here's what billing teams need to know.

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Field	Detail
Payer	Aetna
Policy	Peripheral Vascular Rehabilitation Programs
Policy Code	CPB 0458 Aetna
Change Type	Modified
Effective Date	September 26, 2025
Impact Level	Medium
Specialties Affected	Vascular surgery, cardiology, physical medicine, outpatient rehab
Key Action	Confirm CPT 93668 claims pair with an intermittent claudication ICD-10 from the I70.2xx–I70.7xx or I73.x range — and drop 0631T from PAD rehab claims immediately

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Aetna Peripheral Vascular Rehabilitation Coverage Criteria and Medical Necessity Requirements 2025

The Aetna peripheral vascular rehabilitation coverage policy has one clear focal point: symptomatic peripheral artery disease (PAD) with intermittent claudication. That's the covered indication. Not asymptomatic PAD. Not critical limb ischemia. Not post-revascularization maintenance. Symptomatic PAD with claudication.

Medical necessity under CPB 0458 requires that the patient have documented intermittent claudication. Aetna defines this as the supervised, structured rehabilitation program described under CPT 93668 — peripheral arterial disease rehabilitation, per session. Your documentation needs to support that diagnosis directly.

If your team bills CPT 93668 without a matching intermittent claudication diagnosis code on the claim, expect a claim denial. The ICD-10 specificity requirements here are significant — we'll cover the full code list below, but the coverage policy is built around the I70.211–I70.719 range and selected I73.x codes.

Prior authorization requirements for this service vary by plan. Aetna's coverage policy confirms medical necessity criteria, but individual plan benefits govern whether prior auth is required before the first session. Check the member's plan before scheduling the initial visit — this is not a universal waiver.

The reimbursement path for CPT 93668 runs through meeting both the diagnosis and supervision criteria. If the supervising provider isn't documented properly in the chart, you've built a denial before the claim even leaves your system.

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Aetna Peripheral Vascular Rehabilitation Exclusions and Non-Covered Indications

CPT 0631T is not covered under this policy. Full stop.

CPT 0631T describes transcutaneous visible light hyperspectral imaging measurement of oxyhemoglobin and deoxyhemoglobin. Aetna explicitly classifies this as not covered for the indications listed in CPB 0458. If your vascular team uses hyperspectral imaging as part of their PAD workup, that service doesn't get bundled into a covered PAD rehab claim — and billing it alongside 93668 won't rescue it.

This is the kind of exclusion that shows up in bundled billing scenarios. A provider documents a PAD rehab session and adds 0631T as a functional assessment tool. Aetna sees that combination and denies the excluded code — sometimes dragging the covered code into a review. Separate those claims and educate your providers now.

Screening encounters coded with Z13.6 appear in the covered ICD-10 list, but read that carefully. The Z13.6 code covers screening for cardiovascular disorders, specifically noted here as screening for peripheral artery disease. This is not a primary treatment diagnosis. If you're using Z13.6 as the primary diagnosis for a CPT 93668 claim, that's a problem. Z13.6 belongs in the context of identifying PAD — not billing supervised rehab sessions.

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Coverage Indications at a Glance

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Aetna Peripheral Vascular Rehabilitation Billing Guidelines and Action Items 2025

Here are the steps your billing team needs to take before September 26, 2025.

Copy Action Items

If you're unsure how this applies to your specific plan mix — especially if you see a high volume of Aetna patients with post-revascularization PAD — talk to your compliance officer before the September 26 effective date. The graft-type ICD-10 distinctions (unspecified vs. nonbiological vs. other bypass graft) create real documentation risk if your providers aren't coding them correctly.

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CPT, HCPCS, and ICD-10 Codes for Peripheral Vascular Rehabilitation Under CPB 0458

Covered CPT Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
93668	CPT	Peripheral arterial disease (PAD) rehabilitation, per session

Not Covered / Experimental Codes

Code	Type	Description	Reason Copy
0631T	CPT	Transcutaneous visible light hyperspectral imaging measurement of oxyhemoglobin, deoxyhemoglobin	Not covered for indications listed in CPB 0458

Key ICD-10-CM Diagnosis Codes

Atherosclerosis of Native Arteries — Intermittent Claudication

Atherosclerosis of Unspecified Bypass Graft — Intermittent Claudication

Atherosclerosis of Nonbiological Bypass Graft — Intermittent Claudication

Atherosclerosis of Other Type Bypass Graft — Intermittent Claudication

Peripheral Vascular Diseases

Screening

Code	Description Copy
Z13.6	Encounter for screening for cardiovascular disorders — screening of peripheral artery disease

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