Drug-Eluting Stents — CPB 0621 | AETNA Coverage Update

Aetna modified CPB 0621 covering drug-eluting stents, effective February 27, 2026. Here's what billing teams need to do.

Aetna, a CVS Health company, updated CPB 0621—its drug-eluting stent coverage policy—with changes that affect how you document and bill coronary and peripheral stent procedures. The policy covers CPT codes 92928–92945, 0913T, and 0914T, plus HCPCS codes C1874 and C1875. The C9600–C9608 series appears in the policy as related/referenced codes, not as affirmatively covered codes under the policy's covered-when-criteria-met grouping. If your practice or facility bills for interventional cardiology or peripheral vascular procedures, this update deserves a close read before you submit your next batch of stent claims.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Drug-Eluting Stents — CPB 0621
Policy Code	CPB 0621
Change Type	Modified
Effective Date	February 27, 2026
Impact Level	High
Specialties Affected	Interventional Cardiology, Vascular Surgery, Cardiac Cath Lab, Interventional Radiology
Key Action	Audit medical necessity documentation against updated stenosis thresholds and anti-platelet tolerance criteria before submitting claims dated February 27, 2026 or later

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Aetna Drug-Eluting Stent Coverage Criteria and Medical Necessity Requirements 2026

The core of the Aetna drug-eluting stent coverage policy hinges on three clinical gates. Your patient must have acute coronary syndrome, angina pectoris (stable ischemic heart disease), or silent ischemia. They must also be able to tolerate anti-platelet or anti-coagulant therapy. And they must meet at least one of three stenosis thresholds.

Those thresholds matter. Aetna covers FDA-approved drug-eluting stents—including everolimus-eluting stents like the Xience and Synergy systems, paclitaxel-eluting stents, sirolimus-eluting stents, zotarolimus-eluting stents like the Resolute Onyx, and ridaforolimus-eluting stents like the EluNIR—when the member has any of the following:

#	Covered Indication Copy
1	Left main coronary artery stenosis ≥50% — this is the lowest threshold in the policy and the one most likely to trigger a medical necessity review if documentation is thin
2	Angina pectoris refractory, contraindicated, or intolerant to optimal medical therapy, with ≥70% stenosis in one or more coronary arteries
3	Angina pectoris refractory, contraindicated, or intolerant to optimal medical therapy, with >50% coronary stenosis and FFR ≤0.80

The FFR criterion is the one that trips up billing teams most often. If your physician documents coronary stenosis greater than 50% but doesn't document fractional flow reserve (FFR) results, Aetna has grounds to deny the claim. Make sure your cath lab reports are in the record before you bill CPT 92928, 92929, 92930, or the corresponding HCPCS codes C9600 or C9601.

The policy also covers FDA-approved drug-eluting stents for intra-coronary stent re-stenosis and for coronary lesions in Kawasaki disease. These are narrower indications, but they're covered without the stenosis thresholds above—documentation of the underlying diagnosis is what carries the medical necessity argument.

For peripheral vascular procedures, Aetna covers two specific systems: the Eluvia Drug-Eluting Vascular Stent System for superficial femoral artery and proximal popliteal artery disease, and the Zilver PTX Drug-Eluting Peripheral Stent for femoro-popliteal artery disease. These bill under CPT 37226 and 37227. The stent brand matters here—generic references to "drug-eluting peripheral stent" in your clinical documentation won't be enough if Aetna audits the claim.

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Aetna Drug-Eluting Stent Exclusions and Non-Covered Indications

This is where the policy draws hard lines. Aetna considers the following experimental, investigational, or unproven.

Antibody-coated coronary stents are excluded. So are biodegradable, bioresorbable, bioabsorbable, and magnetically-coated bioabsorbable polymer drug-eluting stents. If your interventionalist is using a newer bioresorbable scaffold, that's not covered under this policy. Document carefully and consider whether a different claim path applies before submitting.

The non-covered indication list for drug-eluting stents is long. Aetna will not cover DES use for any of the following:

One specific call-out: the Eluvia Drug-Eluting Vascular Stent System is covered for superficial femoral and proximal popliteal artery disease, but explicitly not covered for iliac artery stenosis. That's a narrow but meaningful distinction. If your vascular team uses Eluvia for iliac cases, those claims will deny.

If you bill CPT codes 0075T or 0076T for transcatheter vertebral artery stent placement, those are listed as "other related codes"—meaning Aetna's drug-eluting stent coverage policy doesn't affirmatively cover them under CPB 0621. The same goes for CPT 61635 (intracranial stent placement). Both appear in the policy's reference code list, not the covered list.

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Coverage Indications at a Glance

Note: C9600–C9608 are listed as "other related codes" in CPB 0621, not as affirmatively covered codes under the covered-when-criteria-met grouping. Verify payer coverage position for these codes through your payer contract or claims history.

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Aetna Drug-Eluting Stent Billing Guidelines and Action Items 2026

Here's what your billing team and clinical documentation staff need to do now.

Copy Action Items

General Billing Note — Prior Authorization: CPB 0621 does not address prior authorization requirements. Prior auth requirements vary by member plan and are not governed by this clinical policy bulletin. Consult your payer contract or eligibility verification tools for plan-specific prior auth requirements before scheduling elective stent procedures. The reimbursement exposure on interventional cardiology cases is significant—these aren't low-dollar claims.

If your case mix includes a significant volume of peripheral vascular or interventional cardiology procedures, talk to your compliance officer before February 27, 2026 to confirm your documentation standards match the updated criteria.

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CPT, HCPCS, and ICD-10 Codes for Drug-Eluting Stents Under CPB 0621

Covered CPT Codes (When Selection Criteria Are Met)

Other CPT Codes Referenced in CPB 0621

Covered HCPCS Codes (When Selection Criteria Are Met)

Code	Description Copy
C1874	Stent, coated/covered, with delivery system — covered for FDA-approved everolimus, paclitaxel, sirolimus, zotarolimus, and ridaforolimus-eluting stents
C1875	Stent, coated/covered, without delivery system — covered for FDA-approved everolimus, paclitaxel, sirolimus, zotarolimus, and ridaforolimus-eluting stents

Other HCPCS Codes Referenced in CPB 0621

Key ICD-10-CM Diagnosis Codes

The full policy references 209 ICD-10-CM codes. Review the complete list at the Aetna CPB 0621 source policy before finalizing your ICD-10 mapping.

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