Cardioverter-Defibrillators — CPB 0585 | AETNA Coverage Update

Aetna modified CPB 0585 for implantable cardioverter-defibrillators, effective September 26, 2025. Here's what billing teams need to do.

Aetna, a CVS Health company, updated its cardioverter-defibrillator coverage policy under CPB 0585. This change affects a wide range of ICD-related procedures — from transvenous and subcutaneous systems to the newer substernal electrode platform — billed under CPT codes 33249, 33270, 0571T, and dozens more. If your practice or facility bills cardiac device implants, removals, replacements, or remote monitoring for Aetna members, this policy governs your reimbursement.

Quick-Reference Table

Aetna Cardioverter-Defibrillator Coverage Criteria and Medical Necessity Requirements 2025

The Aetna cardioverter-defibrillator coverage policy under CPB 0585 covers ICD implantation and related procedures when specific medical necessity criteria are met. Aetna does not publish a blanket authorization — each patient must meet defined clinical indications.

The policy covers the full spectrum of ICD platforms: transvenous single- and dual-chamber systems (CPT 33249, 33262–33264), subcutaneous ICDs (CPT 33270, 33271), and the substernal electrode system introduced via Category III codes 0571T through 0614T. These are not interchangeable from a billing standpoint. Each platform has its own set of CPT codes, and Aetna treats them as distinct covered services when criteria are met.

Wearable cardioverter-defibrillators are also covered under specific criteria. Bill these under CPT 93745 for the initial set-up and programming, and E0617 or K0606 on the HCPCS side. Get the indication documented clearly in the medical record before submission — wearable devices carry higher scrutiny than implantable systems.

Prior authorization is standard for ICD implantation in most Aetna commercial plans. Confirm prior auth requirements for each specific CPT code, because authorization for CPT 33249 does not automatically extend to CPT 33225 (left ventricular lead insertion) or CPT 33270. Verify separately.

Electrophysiology evaluation codes — CPT 93640, 93641, and 93642 — are listed in the policy as related codes. These are not automatically covered under CPB 0585 alone. Check the member's plan for specific coverage and any separate prior authorization requirements before billing.

CPT 83880 (natriuretic peptide / NT-proBNP) is explicitly not covered for the indications listed in CPB 0585. If you're ordering NT-proBNP as part of an ICD workup and trying to bill it under this policy, expect a claim denial. That's a clean exclusion.

Aetna Cardioverter-Defibrillator Exclusions and Non-Covered Indications

The one explicit non-covered code in CPB 0585 is CPT 83880 — natriuretic peptide testing. Aetna will not pay for NT-proBNP when the indication falls under the scope of this policy. That's a specific, narrow exclusion, but it's worth flagging for cardiology practices that reflexively add natriuretic peptide panels to device clinic workups.

The real exposure here isn't the exclusion list — it's the selection criteria. ICD billing under CPB 0585 lives and dies on medical necessity documentation. If your clinical documentation doesn't support the specific indication Aetna expects, you'll face denials on high-dollar device claims. That's where most billing teams get hurt.

Coverage Indications at a Glance

Aetna Cardioverter-Defibrillator Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. Claims for dates of service on or after that date fall under the updated policy. Here's what to do now.

CPT, HCPCS, and ICD-10 Codes for Cardioverter-Defibrillators Under CPB 0585

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered CPT Codes

Covered HCPCS Codes (When Selection Criteria Are Met)

Related HCPCS Code

Key ICD-10-CM Diagnosis Codes