Thrombectomy Systems — CPB 0568 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0568 covering rheolytic thrombectomy systems, effective September 26, 2025. Here's what billing teams need to know before submitting claims.

Aetna's thrombectomy coverage policy under CPB 0568 has been updated as of September 26, 2025. This policy governs the AngioJet Rheolytic Thrombectomy System — also known as the Possis AngioJet Rapid Thrombectomy System — across a wide range of vascular and cardiac indications. The change affects 21 CPT codes and two HCPCS codes, including CPT 36904, 36905, 36906, 37187, 37188, and add-on code +92973 for coronary thrombectomy. If your team bills thrombectomy procedures for Aetna-insured patients, your charge capture and documentation need to match the updated criteria before September 26, 2025.

Quick-Reference Table

Aetna Thrombectomy Coverage Criteria and Medical Necessity Requirements 2025

Aetna's thrombectomy coverage policy under CPB 0568 covers the AngioJet Rheolytic Thrombectomy System for four clinical scenarios. Each has specific medical necessity requirements. Meeting any one of these criteria is what gets your claim paid — missing documentation on any criterion is what gets it denied.

Scenario 1 — AV Access for Hemodialysis: Aetna covers rheolytic thrombectomy for removing fresh blood clots from arteriovenous fistulas used for hemodialysis. This includes both direct artery-to-vein anastomosis and synthetic graft configurations, such as Gore-Tex. Billing teams should reach for CPT 36904, 36905, or 36906 for dialysis circuit procedures. C1757 (catheter, thrombectomy/embolectomy) is also covered as a HCPCS supply code when selection criteria are met.

Scenario 2 — Coronary Arteries and Bypass Grafts: Aetna covers thrombectomy in coronary arteries or coronary bypass grafts with a diameter of at least 2.0 mm. The procedure must occur before angioplasty or stent placement. Add-on code +92973 (percutaneous transluminal coronary thrombectomy) applies here — it's a list-separately code, so it pairs with the primary coronary intervention code, not as a standalone.

Scenario 3 — Infra-Inguinal Peripheral Arteries: Aetna covers removal of fresh clots from infra-inguinal peripheral arteries at or above 2.0 mm in diameter. Relevant CPT codes include 34201, 34203, 37225, 37227, 37229, 37231, 37233, and 37235, depending on the vessel and whether stenting or atherectomy is involved. Transcatheter thrombolytic infusion codes 37211, 37213, and 37214 may also apply depending on what's performed.

Scenario 4 — Lower Extremity DVT: This is the most documentation-intensive indication. Aetna covers thrombectomy for lower extremity deep vein thrombosis only when pharmacologic thrombolysis has failed or is contraindicated. CPT 37187 and 37188 cover percutaneous transluminal mechanical thrombectomy of veins, including intraprocedural pharmacological thrombolytic injection. CPT 37212 covers venous infusion for thrombolysis when that approach is used alongside mechanical thrombectomy.

Prior authorization requirements are not explicitly detailed in the policy language, but given the clinical complexity and cost of these procedures, treat prior authorization as likely required for all four indications. Confirm with Aetna before scheduling elective cases. Reimbursement exposure is high across all four scenarios — these aren't low-cost procedures, and a claim denial on a rheolytic thrombectomy case hurts.

Aetna Thrombectomy Exclusions and Non-Covered Indications

Three CPT codes are explicitly not covered for the indications listed in CPB 0568. The policy groups them separately, which is a clear signal — Aetna is drawing a hard line.

CPT 34401 (thrombectomy of vena cava or iliac vein by abdominal incision) is not covered when the indication is inferior vena cava filter-related thrombosis.

CPT 34421 (vena cava, iliac, femoropopliteal vein thrombectomy by leg incision) carries the same exclusion — IVC filter-related thrombosis is not a covered indication.

CPT 34451 (vena cava, iliac, femoropopliteal vein thrombectomy by abdominal and leg incision) is also excluded for IVC filter-related thrombosis.

The real issue here is documentation specificity. If a patient has both lower extremity DVT and an IVC filter, the distinction between filter-related and non-filter-related thrombosis becomes critical. A claim using 34401, 34421, or 34451 will not survive audit if the operative notes suggest filter-related disease — even if the primary diagnosis code is DVT. Your physicians need to document the etiology clearly.

HCPCS C7564 (percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injection) is also listed as not covered when selection criteria are not met. This is distinct from C1757, which is covered when criteria are met. Don't mix these two codes up — they're easy to confuse, and the coverage statuses are different.

Coverage Indications at a Glance

Aetna Thrombectomy Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Thrombectomy Systems Under CPB 0568

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered CPT and HCPCS Codes

Key ICD-10-CM Diagnosis Codes

The full ICD-10-CM list under CPB 0568 includes 218 codes spanning pulmonary embolism subcategories (I26.x), acute MI (I21.x–I22.x), coronary artery disease (I25.x), and vascular/DVT diagnoses. Your billing team should pull the complete list from the full CPB 0568 policy document and map it against your EHR's diagnosis code selections. Submitting a claim with an ICD-10 code that isn't on Aetna's covered list for this policy is a clean path to a claim denial, even if the procedure was medically appropriate.