Aetna modified CPB 0665 for constraint-induced movement therapy (CIMT), effective October 8, 2025. Here's what billing teams need to know before submitting claims.
Aetna, a CVS Health company, updated its CIMT coverage policy under CPB 0665 Aetna system. The policy governs reimbursement for upper limb rehabilitation in stroke patients and directly affects CPT codes 97110, 97112, 97530, 92507, and 92508, plus a wide range of peripheral neurostimulator codes (64555–64595) that are explicitly excluded when billed alongside CIMT. If your practice treats post-stroke patients or offers neurorehabilitation services, this policy update sets hard boundaries on what Aetna will pay — and what it won't.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Constraint-Induced Therapy |
| Policy Code | CPB 0665 |
| Change Type | Modified |
| Effective Date | October 8, 2025 |
| Impact Level | High |
| Specialties Affected | Physical therapy, occupational therapy, speech-language pathology, neurology, neurorehabilitation |
| Key Action | Audit all CIMT claims for combination therapy billing before submitting against Aetna plans after October 8, 2025 |
Aetna Constraint-Induced Movement Therapy Coverage Criteria and Medical Necessity Requirements 2025
Aetna's Aetna constraint-induced movement therapy coverage policy is narrow by design. Medical necessity for CIMT applies to exactly one indication: upper limb hemiparesis in stroke patients.
To meet medical necessity criteria, the patient must meet all three of these conditions:
| # | Covered Indication |
|---|---|
| 1 | At least 10 degrees of active wrist and finger extension |
| 2 | No sensory deficits |
| 3 | No cognitive deficits |
All three must be documented. If one is missing, Aetna will deny the claim.
The covered program is a four-week CIMT course. Aetna will authorize an extension for another four weeks — but only if you have documented functional improvement from the initial program. That documentation needs to be in the record before you submit for the extended course. Don't wait until you get a prior authorization request to find it.
Prior authorization requirements for CIMT under Aetna plans are not explicitly detailed in CPB 0665, but given the documentation-heavy medical necessity criteria, treat every CIMT claim as audit-ready. Your clinical notes should clearly reflect the 10-degree extension threshold and the absence of sensory and cognitive deficits at the time treatment begins.
For the extended program, progress notes documenting measurable functional improvement are your reimbursement protection. Without them, Aetna has clear grounds for a claim denial.
Aetna Constraint-Induced Therapy Exclusions and Non-Covered Indications
This is where the policy gets complicated — and where most billing errors will occur.
Aetna classifies CIMT as experimental, investigational, or unproven across a long list of diagnoses and treatment combinations. The real issue here is that many of these are common clinical pairings. Providers who combine CIMT with other modalities or offer it to a broader patient population will face denials.
Excluded diagnoses for CIMT:
Aetna will not cover CIMT for any of the following:
| # | Excluded Procedure |
|---|---|
| 1 | Brachial plexus palsy (G54.0) |
| 2 | Cerebral palsy (G80.0–G80.2) |
| 3 | Congenital hemiplegia |
| 4 | Hemiplegia from brain tumors (C71.0–C71.9) |
| 5 | Lower limb hemiparesis following stroke |
| 6 | Multiple sclerosis (G35) |
| 7 | Parkinson's disease (G20.A1–G20.C) |
| 8 | Spinal cord injury |
| 9 | Traumatic brain injury |
This list matters for your ICD-10 coding. If the primary diagnosis on the claim is any of the above, CIMT is experimental under this coverage policy. Full stop.
Excluded combination therapies:
Aetna also denies CIMT when billed in combination with:
| # | Excluded Procedure |
|---|---|
| 1 | Peripheral nerve stimulation (CPT 64555–64595) |
| 2 | Transcranial direct current stimulation |
| 3 | Transcranial magnetic stimulation (CPT 90867, 90868, 90869) |
| 4 | Biofeedback — auditory or visual — for post-stroke hemiparesis |
| 5 | Electroacupuncture (CPT 97813, 97814) |
| 6 | Peripheral neuromuscular electrical stimulation (CPT 97014, 97032, G0283) |
Group-based CIMT for stroke rehabilitation is also excluded. Constraint-induced aphasia and language therapy — billed under CPT 92507 or 92508 — are not covered under this policy either, whether used alone or alongside TMS.
One addition that stands out: Aetna added constraint-induced cognitive therapy for long COVID brain fog to the experimental list. This reflects a broader industry trend of payers drawing hard lines on COVID-related cognitive rehabilitation. If you've been exploring this as a covered service for Aetna patients, stop. It won't be paid.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Upper limb hemiparesis — stroke, with ≥10° wrist/finger extension, no sensory/cognitive deficits | Covered | 97110, 97112, 97530 | Four-week program; extension requires documented improvement |
| Lower limb hemiparesis — stroke | Experimental | — | Not covered under any circumstances |
| Brachial plexus palsy | Experimental | G54.0 | Experimental regardless of patient profile |
| Cerebral palsy | Experimental | G80.0–G80.2 | All subtypes excluded |
| Congenital hemiplegia | Experimental | — | Not covered |
| Hemiplegia from brain tumors | Experimental | C71.0–C71.9 | All brain tumor subtypes excluded |
| Multiple sclerosis | Experimental | G35 | Not covered |
| Parkinson's disease | Experimental | G20.A1–G20.C | Not covered |
| Spinal cord injury | Experimental | — | Not covered |
| Traumatic brain injury | Experimental | — | Not covered |
| CIMT + peripheral nerve stimulation | Experimental | 64555–64595 | Combination is non-covered |
| CIMT + TMS | Experimental | 90867, 90868, 90869 | Combination is non-covered |
| CIMT + transcranial direct current stimulation | Experimental | — | Non-covered combination |
| CIMT + biofeedback (auditory/visual) | Experimental | — | Non-covered for post-stroke hemiparesis |
| CIMT + electroacupuncture | Experimental | 97813, 97814 | Non-covered for stroke rehabilitation |
| CIMT + neuromuscular electrical stimulation | Experimental | 97014, 97032, G0283 | Non-covered for upper extremity function post-stroke |
| Group-based CIMT — stroke | Experimental | 92508 | Group delivery not covered |
| Constraint-induced aphasia/language therapy | Experimental | 92507, 92508 | Not covered alone or with TMS |
| Constraint-induced cognitive therapy — long COVID brain fog | Experimental | — | Newly added to experimental list |
Aetna Constraint-Induced Movement Therapy Billing Guidelines and Action Items 2025
The effective date is October 8, 2025. These actions apply now.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for combination therapy claims. Pull any active treatment plans that pair CIMT with peripheral nerve stimulation (64555–64595), TMS (90867–90869), electroacupuncture (97813, 97814), or electrical stimulation (97014, 97032, G0283). These combinations are non-covered under the updated Aetna CIMT billing policy. Claims that include both CIMT and these codes on the same date of service — or in the same authorization period — are denial risks. |
| 2 | Check your ICD-10 coding before every CIMT claim. The covered diagnosis is upper limb hemiparesis following stroke. If the primary ICD-10 code on the claim points to cerebral palsy, MS, Parkinson's, traumatic brain injury, brain tumor, brachial plexus disorder, or spinal cord injury, Aetna will deny the claim as experimental. Map your diagnosis codes before submitting. |
| 3 | Build the 10-degree extension threshold into your intake documentation. Your clinical intake for stroke patients starting CIMT should explicitly document wrist and finger extension range of motion. "At least 10 degrees of active wrist and finger extension" is a hard medical necessity criterion. Document it numerically — not descriptively. |
| 4 | Document absence of sensory and cognitive deficits. This is the criterion most practices miss. Aetna requires no sensory deficits and no cognitive deficits. Make sure your initial evaluation notes address both directly. A vague note won't protect you on audit. |
| 5 | Prepare your four-week progress documentation before requesting the extension. If you plan to continue CIMT beyond the initial four-week program, you need documented functional improvement. Set a reminder at week three to assemble that documentation. Don't request the extended authorization without it. |
| 6 | Stop submitting constraint-induced cognitive therapy claims for long COVID patients. Aetna added this indication to the experimental list as of the effective date. Any claims in this category will be denied. If you've already submitted claims for this service, flag them for your billing team and evaluate for potential refund exposure. Talk to your compliance officer before the October 8, 2025 date if you're unsure how this applies to your current patient mix. |
| 7 | Remove group CIMT from your Aetna billing workflows. CPT 92508 for group constraint-induced aphasia therapy is not covered. If your practice offers group-based CIMT or group constraint-induced language therapy, those services are experimental under this policy and will not be reimbursed by Aetna. |
| 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 Constraint-Induced Therapy Under CPB 0665
Covered CPT Codes (When Medical Necessity Criteria Are Met)
These codes support covered CIMT billing for upper limb hemiparesis in eligible stroke patients.
| Code | Type | Description |
|---|---|---|
| 97110 | CPT | Therapeutic exercises to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
| 97112 | CPT | Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception, each 15 minutes |
| 97140 | CPT | Manual therapy techniques, each 15 minutes |
| 97530 | CPT | Therapeutic activities, direct one-on-one patient contact, each 15 minutes |
| G0151 | HCPCS | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
| S9131 | HCPCS | Physical therapy; in home, per diem |
Not Covered / Experimental Codes
These codes are explicitly excluded when billed in combination with CIMT, or are listed under non-covered CIMT indications.
| Code | Type | Description | Reason |
|---|---|---|---|
| 92507 | CPT | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | Constraint-induced aphasia/language therapy — not covered |
| 92508 | CPT | Treatment of speech, language, voice, communication, and/or auditory processing disorder; group | Constraint-induced aphasia/language therapy — not covered; group CIMT — not covered |
| 64555 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64556 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64557 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64558 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64559 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64560 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64561 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64562 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64563 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64564 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64565 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64566 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64567 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64568 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64569 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64570 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64571 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64572 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64573 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64574 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64575 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64576 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64577 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64578 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64579 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64580 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64581 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64582 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64583 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64584 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64585 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64586 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64587 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64588 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64589 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64590 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64591 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64592 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64593 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64594 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 64595 | CPT | Neurostimulator, peripheral nerve | Not covered in combination with CIMT |
| 90867 | CPT | Therapeutic repetitive transcranial magnetic stimulation (TMS); initial, including cortical mapping | Not covered in combination with CIMT |
| 90868 | CPT | Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent delivery and management | Not covered in combination with CIMT |
| 90869 | CPT | Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent motor threshold redetermination | Not covered in combination with CIMT |
| 95970 | CPT | Electronic analysis and programming of neurostimulator pulse generator | Not covered in combination with CIMT |
| 95971 | CPT | Electronic analysis and programming of neurostimulator pulse generator | Not covered in combination with CIMT |
| 95972 | CPT | Electronic analysis and programming of neurostimulator pulse generator | Not covered in combination with CIMT |
| 95973 | CPT | Electronic analysis and programming of neurostimulator pulse generator | Not covered in combination with CIMT |
| 95974 | CPT | Electronic analysis and programming of neurostimulator pulse generator | Not covered in combination with CIMT |
| 95975 | CPT | Electronic analysis and programming of neurostimulator pulse generator | Not covered in combination with CIMT |
| 97014 | CPT | Application of a modality; electrical stimulation (unattended) | Not covered in combination with CIMT for post-stroke upper extremity |
| 97032 | CPT | Application of a modality; electrical stimulation (manual), each 15 minutes | Not covered in combination with CIMT for post-stroke upper extremity |
| 97813 | CPT | Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes | Not covered in combination with CIMT for stroke rehabilitation |
| 97814 | CPT | Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes | Not covered in combination with CIMT for stroke rehabilitation |
| G0283 | HCPCS | Electrical stimulation (unattended), to one or more areas for indications other than wound care | Not covered in combination with CIMT |
Key ICD-10-CM Diagnosis Codes
| Code | Description | Coverage Status |
|---|---|---|
| C71.0–C71.9 | Malignant neoplasm of brain (all subtypes) | Experimental — CIMT not covered |
| G20.A1–G20.C | Parkinson's disease | Experimental — CIMT not covered |
| G21.11–G21.9 | Secondary parkinsonism | Experimental — CIMT not covered |
| G35 | Multiple sclerosis | Experimental — CIMT not covered |
| G54.0 | Brachial plexus disorders | Experimental — CIMT not covered |
| G80.0 | Spastic quadriplegic cerebral palsy | Experimental — CIMT not covered |
| G80.1 | Spastic diplegic cerebral palsy | Experimental — CIMT not covered |
| G80.2 | Spastic hemiplegic cerebral palsy | Experimental — CIMT not covered |
Stroke ICD-10 codes supporting covered CIMT are included in the full policy code set (225 ICD-10-CM codes total). Review the complete code list at CPB 0665 on Aetna's policy site to confirm stroke-specific codes for your claims.
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