TL;DR: Aetna, a CVS Health company, modified CPB 0621 covering drug-eluting stents, effective February 27, 2026. Billing teams using CPT codes 92928–92945, 0913T, and 0914T — and HCPCS codes C1874, C1875, and C9600–C9608 — need to verify their charge capture and medical necessity documentation align with the updated criteria before submitting claims.
This Aetna drug-eluting stent coverage policy update under CPB 0621 Aetna's clinical policy framework clarifies which stent types, vessel locations, and clinical indications qualify for coverage — and draws a hard line around what doesn't. The policy covers a wide range of FDA-approved coronary stent systems (everolimus-, paclitaxel-, sirolimus-, zotarolimus-, and ridaforolimus-eluting) as well as two named peripheral stent systems. If your team bills for interventional cardiology or vascular procedures, this update touches nearly every stent-related code in your charge master.
Quick-Reference Table
| Field | Detail |
|---|---|
| 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, Cardiology, Gastroenterology (where stents are excluded) |
| Key Action | Audit claim documentation for stenosis percentage, FFR values, and anti-platelet tolerance before billing CPT 92928–92945 or HCPCS C9600–C9608 |
Aetna Drug-Eluting Stent Coverage Criteria and Medical Necessity Requirements 2026
The core of this coverage policy comes down to three clinical thresholds. All are required to meet medical necessity under CPB 0621.
First, the member must have acute coronary syndrome, stable ischemic heart disease (angina pectoris), or silent ischemia. They must also be able to tolerate anti-platelet or anti-coagulant therapy. Without both of those baseline conditions, you don't have a covered case.
Then the member must meet at least one of the following stenosis criteria:
| # | Covered Indication |
|---|---|
| 1 | ≥50% stenosis in the left main coronary artery |
| 2 | ≥70% stenosis in one or more coronary arteries, with angina that is refractory, contraindicated, or intolerant to optimal medical therapy |
| 3 | >50% stenosis with fractional flow reserve (FFR) ≤0.80, again with refractory, contraindicated, or intolerant angina |
The FFR threshold is worth flagging. Aetna uses ≤0.80 as the coverage trigger. If your cath lab documents FFR values but doesn't tie them to stenosis percentage and clinical intolerance to medical therapy, you're leaving a gap in your medical necessity argument.
Drug-eluting stent billing also gets coverage for two additional coronary indications: intra-coronary stent restenosis and coronary lesions in Kawasaki disease. Both require FDA-approved stent systems.
On the peripheral side, Aetna's coverage policy specifically names two stent systems for two specific vessels. The Eluvia Drug-Eluting Vascular Stent System covers primary treatment of superficial femoral artery and proximal popliteal artery disease. The Zilver PTX Drug-Eluting Peripheral Stent covers primary treatment of femoro-popliteal artery disease. These are the only peripheral stent systems named as covered. Any other system — or any other vessel — is not covered.
Prior authorization requirements are not detailed in CPB 0621. Confirm your Aetna prior auth requirements for coronary stent procedures directly with Aetna before scheduling elective cases.
Aetna Drug-Eluting Stent Exclusions and Non-Covered Indications
The experimental and investigational list in CPB 0621 is long. Aetna does not cover these — and several of them are clinical situations where providers sometimes attempt stent placement expecting coverage.
Antibody-coated coronary stents are not covered. Neither are biodegradable, bioresorbable, bioabsorbable, or magnetically-coated bioabsorbable polymer drug-eluting stents. The word "biodegradable" here is the trap. Some providers assume newer-generation bioresorbable scaffolds fall under the same coverage umbrella as metallic DES. They don't under this policy.
The non-coronary and off-label indications are also explicitly excluded. Aetna will deny claims for drug-eluting stents used to treat:
| # | Excluded Procedure |
|---|---|
| 1 | Aorto-arteritis (Takayasu arteritis) |
| 2 | Arteriovenous graft outflow vein stenosis in hemodialysis patients |
| 3 | Chronic kidney disease with multi-vessel disease |
| 4 | Coronary artery aneurysms |
| 5 | Esophageal stricture or dysphagia (benign or malignant) |
| 6 | Gastric outlet obstruction |
| 7 | Intracranial atherosclerotic stenosis |
| 8 | Myocardial bridging of the coronary arteries |
| 9 | Pancreato-biliary diseases including ERCP applications |
| 10 | Pulmonary vein stenosis |
| 11 | Renal artery aneurysm |
| 12 | Stenotic lesions of non-coronary arteries — including carotid artery stenosis, renal artery stenosis, and vertebral artery stenosis |
| 13 | Vein graft stenosis |
| 14 | Venous stenosis associated with dialysis vascular access |
The Eluvia system for iliac artery stenosis is also explicitly excluded. This is the same Eluvia stent that's covered for SFA and proximal popliteal — the vessel location is the determining factor. Document the vessel carefully.
The real issue here is the GI and biliary exclusions. Gastroenterology teams occasionally bill drug-eluting stents for esophageal or biliary indications. Under this coverage policy, those claims will be denied. If that's part of your mix, talk to your compliance officer before the effective date of February 27, 2026.
Coverage Indications at a Glance
| Indication | Status | Notes |
|---|---|---|
| ACS, stable angina, or silent ischemia with ≥50% left main stenosis | Covered | Must tolerate anti-platelet/anti-coagulant therapy; use FDA-approved DES |
| Refractory angina with ≥70% stenosis in ≥1 coronary artery | Covered | Optimal medical therapy must be refractory, contraindicated, or intolerant |
| Refractory angina with >50% stenosis and FFR ≤0.80 | Covered | FFR value must be documented in the record |
| Intra-coronary stent restenosis | Covered | FDA-approved DES required |
| Coronary lesions in Kawasaki disease | Covered | FDA-approved DES required |
| Superficial femoral / proximal popliteal artery disease (Eluvia system) | Covered | Eluvia system only; primary treatment only |
| Femoro-popliteal artery disease (Zilver PTX) | Covered | Zilver PTX only |
| Biodegradable / bioresorbable / bioabsorbable polymer DES | Experimental | Not covered under any indication |
| Antibody-coated coronary stents | Experimental | Not covered under any indication |
| Esophageal stricture / dysphagia | Not Covered | Claim denial risk; GI teams should audit billing practices |
| Intracranial atherosclerotic stenosis | Not Covered | Neurovascular teams should note this exclusion |
| Carotid, renal, vertebral artery stenosis | Not Covered | Non-coronary artery stenosis excluded |
| Hemodialysis AV graft outflow vein stenosis | Not Covered | Dialysis access exclusion |
| Iliac artery stenosis (Eluvia system) | Not Covered | Different vessel from covered SFA/popliteal indication |
| Pancreato-biliary diseases / ERCP applications | Not Covered | Hepatobiliary and GI exclusion |
| Gastric outlet obstruction | Not Covered | GI exclusion |
| Coronary artery aneurysm | Not Covered | Separate from covered ACS indications |
| Vein graft stenosis | Not Covered | Distinct from covered bypass graft revascularization codes |
| Pulmonary vein stenosis | Not Covered | — |
| Venous stenosis with dialysis vascular access | Not Covered | — |
Note: CPB 0621 categorizes codes as "covered when selection criteria are met" or "other codes related to the CPB" — it does not map individual codes to specific indications. See the full code tables below and confirm code selection with your billing team based on the procedure performed.
Aetna Drug-Eluting Stent Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your stenosis and FFR documentation before February 27, 2026. Aetna's medical necessity criteria require specific numerical thresholds — ≥50%, ≥70%, FFR ≤0.80. Vague documentation like "significant stenosis" will not support a claim. Your cath lab reports need to include the exact percentages and, where used, the FFR measurement. |
| 2 | Update charge capture to flag biodegradable and bioresorbable stent systems separately. These are not covered under CPB 0621. If your supply chain includes bioresorbable scaffolds, make sure your billing team knows they fall in the experimental bucket — not the covered DES bucket. |
| 3 | Verify peripheral stent claims name the correct stent system and vessel. Reimbursement for peripheral DES billing under CPT 37224–37227 depends on both the stent brand (Eluvia or Zilver PTX) and the vessel (SFA, proximal popliteal, or femoro-popliteal). Bill the wrong vessel — like iliac — and Aetna will deny the claim. Train coders to confirm vessel location in the operative report. |
| 4 | Review your GI and biliary stent claims before the effective date. If your gastroenterology or hepatobiliary team has been billing drug-eluting stents for esophageal, biliary, or pancreatic indications, those claims are not covered under this policy. Pull your last 90 days of claims for ICD-10 codes in the K20–K93 range paired with stent CPT/HCPCS codes. Talk to your compliance officer if you find a pattern. |
| 5 | Confirm prior authorization requirements directly with Aetna before scheduling elective coronary stent procedures. CPB 0621 does not specify which codes require prior auth or under what plans. Contact Aetna directly — or check your plan-level agreements — to confirm PA requirements before scheduling elective PCI. |
| 6 | Confirm anti-platelet tolerance documentation is in the record. Aetna requires that the member be able to tolerate anti-platelet or anti-coagulant therapy as a baseline criterion. If that clinical determination isn't documented — or if there's a contraindication that isn't addressed — expect a medical necessity denial. |
| 7 | Separate bypass graft revascularization from vein graft stenosis. CPT 92937, 92938, and HCPCS C9604, C9605 cover revascularization of coronary artery bypass grafts. Vein graft stenosis is excluded. The distinction is the clinical scenario, not just the vessel — make sure ICD-10 coding reflects the right condition. |
| 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 Drug-Eluting Stents Under CPB 0621
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 0913T | CPT | Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon |
| 0914T | CPT | Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon (additional vessel) |
Other CPT Codes Related to CPB 0621
| Code | Type | Description |
|---|---|---|
| 0075T–0076T | CPT | Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision |
| 37224 | CPT | Revascularization, endovascular, femoral/popliteal artery(s), unilateral; with transluminal angioplasty |
| 37225 | CPT | With atherectomy, includes angioplasty within the same vessel |
| 37226 | CPT | With transluminal stent placement(s), includes angioplasty within the same vessel |
| 37227 | CPT | With transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel |
| 37236 | CPT | Transcatheter placement of an intravascular stent(s) (except lower extremity artery for occlusive disease) |
| 37237 | CPT | Transcatheter placement of an intravascular stent(s), additional vessel |
| 37238 | CPT | Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision |
| 37239 | CPT | Transcatheter placement of an intravascular stent(s), open or percutaneous, additional vessel |
| 61635 | CPT | Transcatheter placement of intravascular stent(s), intracranial (e.g., atherosclerotic stenosis) |
| 92928 | CPT | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty — major coronary artery or branch |
| 92929 | CPT | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty — each additional branch |
| 92930 | CPT | Percutaneous transcatheter placement of intracoronary stent(s), without coronary angioplasty — major coronary artery or branch |
| 92933 | CPT | Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty — major coronary artery |
| 92934 | CPT | Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty — each additional branch |
| 92937 | CPT | Percutaneous transluminal revascularization of or through coronary artery bypass graft |
| 92938 | CPT | Percutaneous transluminal revascularization of or through coronary artery bypass graft, each additional vessel |
| 92941 | CPT | Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction |
| 92943 | CPT | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery |
| 92944 | CPT | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery — each additional vessel |
| 92945 | CPT | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery — additional branch of major coronary artery |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| C1874 | HCPCS | Stent, coated/covered, with delivery system — covered for FDA-approved everolimus, paclitaxel, sirolimus, zotarolimus, and ridaforolimus-eluting stents |
| C1875 | HCPCS | Stent, coated/covered, without delivery system — covered for FDA-approved everolimus, paclitaxel, sirolimus, zotarolimus, and ridaforolimus-eluting stents |
Other HCPCS Codes Related to CPB 0621
| Code | Type | Description |
|---|---|---|
| C9600 | HCPCS | Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty — major coronary artery or branch |
| C9601 | HCPCS | Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty — each additional branch |
| C9602 | HCPCS | Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty — major coronary artery |
| C9603 | HCPCS | Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty — each additional branch |
| C9604 | HCPCS | Percutaneous transluminal revascularization of or through coronary artery bypass graft with drug-eluting stent |
| C9605 | HCPCS | Percutaneous transluminal revascularization of or through coronary artery bypass graft with drug-eluting stent — each additional vessel |
| C9606 | HCPCS | Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction with drug-eluting stent |
| C9607 | HCPCS | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery with drug-eluting stent |
| C9608 | HCPCS | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery with drug-eluting stent — each additional vessel |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| I20.0 | Unstable angina |
| I20.1–I20.9 | Angina pectoris (various subtypes) |
| I24.9 | Acute ischemic heart disease, unspecified (Acute coronary syndrome) |
| I25.10–I25.119 | Atherosclerotic heart disease of native coronary artery without and with angina pectoris |
| I25.3 | Aneurysm of heart |
| I25.41 | Coronary artery aneurysm |
| I25.42 | Coronary artery dissection |
| I25.5 | Ischemic cardiomyopathy |
| I25.6 | Silent myocardial ischemia |
| I25.700–I25.719 | Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with various angina subtypes |
| I25.720–I25.728 | Atherosclerosis of coronary artery bypass graft(s) — autologous artery, with various angina subtypes |
Note: CPB 0621 includes 209 ICD-10-CM codes in total. The table above reflects the primary diagnosis codes most relevant to coronary and peripheral stent billing. Pull the full ICD-10 list from the source policy at PayerPolicy before updating your billing guidelines.
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