Anesthetic and Antiemetic Infusion Pumps — CPB 0607 | AETNA Coverage Update

Aetna modified CPB 0607 for anesthetic and antiemetic infusion pumps, effective February 27, 2026. Here's what billing teams need to know before submitting another claim.

Aetna, a CVS Health company, updated its Aetna infusion pump coverage policy under CPB 0607 in the CPB 0607 Aetna system, adding specific pump models and surgical indications to its experimental designation list. The updated policy directly affects claims billed under HCPCS codes A4305, A4306, C9804, C9806, C9811, C9815, C9816, E0780, E0781, E0782, and E0783 — along with dozens of CPT codes spanning bariatric, cardiothoracic, hernia repair, and cholecystectomy procedures. If your practice bills anesthetic infusion pumps post-surgery, this coverage policy affects your reimbursement now.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Anesthetic and Antiemetic Infusion Pumps
Policy Code	CPB 0607
Change Type	Modified
Effective Date	February 27, 2026
Impact Level	High
Specialties Affected	General surgery, orthopedic surgery, bariatric surgery, cardiothoracic surgery, breast reconstruction, pain management, OB/GYN
Key Action	Audit charge capture for infusion pump HCPCS codes billed alongside the excluded surgical CPT codes before submitting any claims dated on or after February 27, 2026

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Aetna Anesthetic Infusion Pump Coverage Criteria and Medical Necessity Requirements 2026

The Aetna anesthetic and antiemetic infusion pump coverage policy under CPB 0607 is almost entirely a policy of exclusions. There are no affirmative medical necessity criteria that unlock coverage for the pumps listed here. Aetna's position is that the evidence doesn't support these pumps for most post-surgical pain indications.

This is a significant financial exposure point. Surgical teams often assume infusion pump reimbursement is a given after procedures like laparoscopic cholecystectomy (CPT 47562–47564) or open inguinal hernia repair (CPT 49491–49525). Under this policy, it is not.

The policy does carve out one important exception: continuous peripheral nerve blocks — including brachial plexus blocks, femoral nerve blocks, and intercostal blocks — are not governed by CPB 0607. If your practice bills those, you're looking at a different policy. Don't confuse the two when building your medical necessity documentation.

Prior authorization data is not explicitly detailed in this policy. That means your standard prior auth workflow applies, but given the scope of experimental designations here, getting ahead of any prior authorization requirements for edge cases is the right move.

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Aetna Anesthetic Infusion Pump Exclusions and Non-Covered Indications

This is where the policy does most of its work — and where your claim denial risk lives.

Aetna designates the following as experimental, investigational, or unproven. The stated reason is the same in each case: effectiveness has not been shown in well-designed clinical studies in peer-reviewed literature.

The ambIT disposable electronic infusion pump (billed under C9806 or C9816) for post-surgical pain management is explicitly excluded. If your ASC or hospital uses the ambIT pump and bills it with any of the excluded surgical CPT codes, expect denials.

Intra-articular and intralesional administration of narcotic analgesics and anesthetics via infusion pump is excluded. This is broader than it looks. Any pump — elastomeric, electronic, or mechanical — delivering narcotics or anesthetics directly into a joint or lesion is out.

Local administration of narcotic analgesics and anesthetics via infusion pump is excluded when paired with these eight specific procedures:

Continuous subcutaneous antiemetic pumps are excluded across the board. This affects practices using subcutaneous infusion of antiemetics like ondansetron, granisetron, or dolasetron post-operatively or for chemotherapy-related nausea.

Elastomeric pumps for home IV antibiotics — specifically the On-Q Pump (C9804) used for home intravenous antibiotic delivery — are excluded. This catches practices that bill elastomeric pumps in a broader antibiotic delivery context, not just pain management.

Esketamine IV analgesic pumps (billed under E0780) for post-cesarean pain or depression are explicitly excluded. This is a specific and growing use case in obstetric anesthesia, and Aetna is drawing a hard line here.

Hepatic arterial infusion pump chemotherapy for unresectable intrahepatic cholangiocarcinoma is excluded. If you have oncology or hepatobiliary surgery cases with this diagnosis, flag those claims immediately.

One more item that often catches billing teams off guard: disposable intralesional anesthetic infusion pumps inserted during surgery are classified as surgical supplies. They're integral to the procedure. Aetna does not reimburse them separately. Billing A4305 or A4306 on top of the surgical CPT code for an intralesional pump will result in a claim denial.

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Coverage Indications at a Glance

Note: The source policy (CPB 0607) groups all listed HCPCS codes collectively as "not covered for indications listed in the CPB." The HCPCS code assignments in this table are illustrative — they reflect common billing contexts for each indication, not explicit code-to-indication mappings stated in the source policy. Any of the listed HCPCS codes may apply across multiple excluded indications. Verify against the full policy at app.payerpolicy.org/p/aetna/0607 before building payer-specific edits.

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Aetna Anesthetic Infusion Pump Billing Guidelines and Action Items 2026

The effective date of February 27, 2026 has already passed. That means this policy is active now. Here's what to do.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Anesthetic and Antiemetic Infusion Pumps Under CPB 0607

HCPCS Codes — Not Covered for Indications Listed in CPB 0607

HCPCS Codes — Other Codes Related to CPB 0607

CPT Codes — Procedures Tied to Excluded Infusion Pump Indications

ICD-10-CM Codes

The policy references 208 ICD-10-CM codes. The full code list is available in the source policy document at app.payerpolicy.org/p/aetna/0607. Pull the complete ICD-10 list from the source before updating your billing guidelines or building payer-specific edits.

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