Aetna modified CPB 0503 covering suction pumps and associated supplies, effective September 26, 2025. Here's what billing teams need to know before submitting claims under E0600, E2000, K0743, and the full suite of related HCPCS codes.
Aetna updated its suction pump coverage policy under CPB 0503, affecting respiratory suction pumps (E0600), gastric suction pumps (E2000), portable wound suction pumps (K0743), and 13 additional HCPCS supply codes. The update also formally designates CPT codes 0870T–0875T — the subcutaneous peritoneal ascites pump series — as non-covered under this policy. If your practice or DME supplier bills any of these codes to Aetna, your charge capture and documentation protocols need review before September 26, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna |
| Policy | Suction Pumps — CPB 0503 |
| Policy Code | CPB 0503 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium |
| Specialties Affected | DME suppliers, pulmonology, gastroenterology, wound care, head and neck oncology, home health |
| Key Action | Audit all active Aetna suction pump claims for medical necessity documentation before September 26, 2025 |
Aetna Suction Pump Coverage Criteria and Medical Necessity Requirements 2025
Aetna's suction pump coverage policy covers a range of suction devices and supplies when selection criteria are met. The three main device categories are respiratory suction pumps (E0600), gastric suction pumps (E2000), and portable home wound suction pumps (K0743).
Medical necessity is the threshold here. Aetna requires that the clinical indication justify the specific device being billed. The policy references ICD-10 codes in the context of CPB 0503, but does not explicitly map individual diagnosis codes to individual device codes. Your documentation needs to connect the patient's diagnosis to the specific device billed.
Respiratory Suction Pumps (E0600)
E0600 covers home-use respiratory suction pumps, both portable and stationary. Associated supplies that are covered when selection criteria are met include tracheal suction catheters — closed system (A4605) and open system (A4624) — oropharyngeal suction catheters (A4628), and oral interface accessories (A7047). Sterile water and saline (A4216, A4217) and non-sterile gloves (A4927) also carry covered status when criteria are satisfied.
The related tracheostomy supply codes (A7501–A7527, A4481, A4623, A4629) are grouped as "other HCPCS codes related to the CPB." These aren't automatically covered under CPB 0503 — they're related codes that may be billed alongside but require their own coverage determination.
Gastric Suction Pumps (E2000)
E2000 covers home-model gastric suction pumps. The policy references ICD-10 codes including gastroparesis (K31.84), aphagia and dysphagia (R13.0–R13.17), and malignant neoplasms of the oral cavity and pharynx (C03.0–C14.8) within CPB 0503. The policy does not explicitly map these diagnosis codes to E2000 specifically. Ensure the patient's diagnosis supports medical necessity for the device billed, and document that connection clearly in the record.
Wound Suction Pumps (K0743)
K0743 is the portable home wound suction pump. The associated wound dressing codes — K0744 (pad size 16 square inches or less), K0745 (pad size more than 16 square inches), and K0746 (pad size greater than 48 square inches) — are covered when selection criteria are met. Disposable wound suction with dressing (A9272) is also covered. Bill the dressing code that matches the actual pad size used. Upcoding to K0746 on a 20-square-inch wound is the fastest route to a claim denial.
Canister and tubing codes — A7000 (disposable canister), A7001 (non-disposable canister), and A7002 (tubing) — apply across suction pump types and are covered when criteria are met.
Prior Authorization
The policy does not address prior authorization requirements. Verify prior auth requirements through the member's specific plan or Aetna provider services before submitting.
Aetna Suction Pump Exclusions and Non-Covered Indications
This is where the update gets interesting. CPT codes 0870T through 0875T — the full subcutaneous peritoneal ascites pump system series — are explicitly designated as not covered for the indications listed in CPB 0503. The policy does not provide clinical rationale for this exclusion.
This matters for hepatology and oncology billing teams. If a surgeon or interventional radiologist implanted one of these systems and your team is trying to find a path to reimbursement under Aetna, CPB 0503 closes that door. The codes and their non-covered designation are:
| # | Excluded Procedure |
|---|---|
| 1 | 0870T — Implantation of subcutaneous peritoneal ascites pump system |
| 2 | 0871T — Replacement of subcutaneous peritoneal ascites pump |
| 3 | 0872T — Replacement of indwelling bladder and peritoneal catheters |
| 4 | 0873T — Revision of subcutaneously implanted peritoneal ascites pump system |
| 5 | 0874T — Removal of peritoneal ascites pump system |
| 6 | 0875T — Programming of subcutaneously implanted peritoneal ascites pump system |
If you're already billing or planning to bill any of these codes to Aetna, talk to your compliance officer before the effective date of September 26, 2025. A non-covered designation doesn't always mean zero reimbursement path — there may be appeal options or plan-level exceptions — but you need compliance and legal eyes on it before submitting.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Respiratory suction — home use | Covered (criteria required) | E0600, A4605, A4624, A4628, A4216, A4217, A4927, A7047 | Document clinical need for home suction; tracheostomy supply codes (A7501–A7527) are related but separately evaluated |
| Gastric suction — home use | Covered (criteria required) | E2000, A7000, A7001, A7002 | Ensure patient diagnosis supports medical necessity for device billed; policy does not explicitly map diagnosis codes to individual devices |
| Wound suction — home portable | Covered (criteria required) | K0743, K0744, K0745, K0746, A9272, A7000, A7001, A7002 | Bill dressing code matching actual pad size; document wound measurements |
| Subcutaneous peritoneal ascites pump — implantation | Not Covered | 0870T | Explicitly excluded under CPB 0503 |
| Subcutaneous peritoneal ascites pump — replacement | Not Covered | 0871T | Explicitly excluded under CPB 0503 |
| Peritoneal/bladder catheter replacement | Not Covered | 0872T | Explicitly excluded under CPB 0503 |
| Ascites pump system — revision | Not Covered | 0873T | Explicitly excluded under CPB 0503 |
| Ascites pump system — removal | Not Covered | 0874T | Explicitly excluded under CPB 0503 |
| Ascites pump system — programming | Not Covered | 0875T | Explicitly excluded under CPB 0503 |
| Dysphagia / aphagia | Referenced in CPB 0503 | R13.0–R13.17 | Policy does not explicitly map to a specific device; ensure diagnosis supports medical necessity for device billed |
| Head and neck malignancy | Referenced in CPB 0503 | C03.0–C14.8 | Policy does not explicitly map to a specific device; does not unlock 0870T–0875T |
| Gastroparesis | Referenced in CPB 0503 | K31.84 | Policy does not explicitly map to a specific device; ensure diagnosis supports medical necessity for device billed |
| Liver cell carcinoma | Referenced in CPB 0503 | C22.0 | 0870T–0875T remain non-covered even with this diagnosis |
Aetna Suction Pump Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit active Aetna suction pump claims before September 26, 2025. Pull all open and pending claims for E0600, E2000, K0743, and their associated supply codes. Confirm each claim has documentation linking the diagnosis to the device and the device to home-use medical necessity. |
| 2 | Map your wound dressing claims to actual pad sizes. If you're billing K0744, K0745, or K0746, your documentation needs to show the wound dimensions that justify the code. Measure and record at each dressing change. This is the kind of thing that triggers a claim denial on audit — and it's easy to fix before submission. |
| 3 | Remove 0870T–0875T from any Aetna charge capture templates that include them. These codes are now explicitly non-covered under CPB 0503. If they're sitting in your charge capture for Aetna patients, you're generating claims that will deny. Update your templates now, before the effective date. |
| 4 | Verify prior authorization requirements at the plan level for each Aetna member. CPB 0503 does not address prior auth requirements. Check the member's specific plan or contact Aetna provider services before submitting. |
| 5 | Review ICD-10 linkage for all suction pump claims. CPB 0503 references diagnosis codes including gastroparesis (K31.84), dysphagia (R13.10–R13.17), and head/neck malignancies (C03.0–C14.8), among others. The policy does not explicitly map individual diagnosis codes to individual device codes. As a general billing best practice, ensure the patient's documented diagnosis clearly supports medical necessity for the specific device billed. Claims that go out with unrelated or poorly documented diagnoses are at risk. |
| 6 | If your practice or facility was billing 0870T–0875T to Aetna, loop in your compliance officer now. Don't wait for the denials to arrive. A proactive review of those claims and a clear appeals strategy — or a patient financial counseling conversation — is far better than managing a retroactive overpayment demand. |
| 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 Suction Pumps Under CPB 0503
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| A4216 | HCPCS | Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
| A4217 | HCPCS | Sterile water/saline, 500 ml |
| A4605 | HCPCS | Tracheal suction catheter, closed system, each |
| A4624 | HCPCS | Tracheal suction catheter, any type other than closed system, each |
| A4628 | HCPCS | Oropharyngeal suction catheter, each |
| A4927 | HCPCS | Gloves, non-sterile, per 100 |
| A7000 | HCPCS | Canister, disposable, used with suction pump, each |
| A7001 | HCPCS | Canister, non-disposable, used with suction pump, each |
| A7002 | HCPCS | Tubing, used with suction pump, each |
| A9272 | HCPCS | Wound suction, disposable, including dressing, all accessories and components, any type, each |
| E0600 | HCPCS | Respiratory suction pump, home model, portable or stationary, electric |
| E2000 | HCPCS | Gastric suction pump, home model, portable or stationary, electric |
| K0743 | HCPCS | Suction pump, home model, portable, for use on wounds |
| K0744 | HCPCS | Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less |
| K0745 | HCPCS | Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches |
| K0746 | HCPCS | Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches |
Other HCPCS Codes Related to CPB 0503 (Separately Evaluated)
| Code | Type | Description |
|---|---|---|
| A4481 | HCPCS | Tracheostoma filter, any type, any size, each |
| A4623 | HCPCS | Tracheostomy, inner cannula |
| A4629 | HCPCS | Tracheostomy care kit for established tracheostomy |
| A7047 | HCPCS | Oral interface used with respiratory suction pump, each |
| A7501 | HCPCS | Tracheostomy supplies |
| A7502 | HCPCS | Tracheostomy supplies |
| A7503 | HCPCS | Tracheostomy supplies |
| A7504 | HCPCS | Tracheostomy supplies |
| A7505 | HCPCS | Tracheostomy supplies |
| A7506 | HCPCS | Tracheostomy supplies |
| A7507 | HCPCS | Tracheostomy supplies |
| A7508 | HCPCS | Tracheostomy supplies |
| A7509 | HCPCS | Tracheostomy supplies |
| A7510 | HCPCS | Tracheostomy supplies |
| A7511 | HCPCS | Tracheostomy supplies |
| A7512 | HCPCS | Tracheostomy supplies |
| A7513 | HCPCS | Tracheostomy supplies |
| A7514 | HCPCS | Tracheostomy supplies |
| A7515 | HCPCS | Tracheostomy supplies |
| A7516 | HCPCS | Tracheostomy supplies |
| A7517 | HCPCS | Tracheostomy supplies |
| A7518 | HCPCS | Tracheostomy supplies |
| A7519 | HCPCS | Tracheostomy supplies |
| A7520 | HCPCS | Tracheostomy supplies |
| A7521 | HCPCS | Tracheostomy supplies |
| A7522 | HCPCS | Tracheostomy supplies |
| A7523 | HCPCS | Tracheostomy supplies |
| A7524 | HCPCS | Tracheostomy supplies |
| A7525 | HCPCS | Tracheostomy supplies |
| A7526 | HCPCS | Tracheostomy supplies |
| A7527 | HCPCS | Tracheostomy supplies |
Non-Covered CPT Codes Under CPB 0503
| Code | Type | Description | Reason |
|---|---|---|---|
| 0870T | CPT | Implantation of subcutaneous peritoneal ascites pump system, percutaneous, including pump-pocket creation | Not covered for indications listed in CPB 0503 |
| 0871T | CPT | Replacement of a subcutaneous peritoneal ascites pump, including reconnection between pump and indwelling catheter | Not covered for indications listed in CPB 0503 |
| 0872T | CPT | Replacement of indwelling bladder and peritoneal catheters, including tunneling of catheter(s) and connection to pump | Not covered for indications listed in CPB 0503 |
| 0873T | CPT | Revision of a subcutaneously implanted peritoneal ascites pump system, any component | Not covered for indications listed in CPB 0503 |
| 0874T | CPT | Removal of a peritoneal ascites pump system, including implanted peritoneal ascites pump and indwelling catheters | Not covered for indications listed in CPB 0503 |
| 0875T | CPT | Programming of subcutaneously implanted peritoneal ascites pump system by physician or other qualified healthcare professional | Not covered for indications listed in CPB 0503 |
Key ICD-10-CM Diagnosis Codes Referenced in CPB 0503
| Code | Description |
|---|---|
| C03.0–C06.9 | Malignant neoplasm of gum and oral cavity |
| C09.0–C14.8 | Malignant neoplasm of pharynx |
| C22.0 | Liver cell carcinoma |
| D00.0–D00.8 | Carcinoma in situ of lip, oral cavity, and pharynx |
| D10.0–D11.9, D13.0 | Benign neoplasm of mouth, pharynx, oral cavity, major salivary glands, and esophagus |
| J39.0–J39.2 | Other diseases of pharynx |
| K31.84 | Gastroparesis |
| K40.00–K46.9 | Hernia |
| R13.0 | Aphagia |
| R13.10–R13.17 | Dysphagia |
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