Blood and Adipose Tissue Derived Products for Selected Indications — CPB 0784 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0784 — its blood and adipose tissue derived products coverage policy — effective November 21, 2025. Every indication covered under this policy is classified as experimental, investigational, or unproven. If your billing team submits claims for PRP injections, autologous blood therapy, or adipose-derived stem cell procedures, expect denials across the board.

This policy covers 42 CPT codes and four HCPCS codes, including CPT 0232T (platelet-rich plasma injection), CPT 0565T and 0566T (autologous cellular implant for knee osteoarthritis), CPT 0717T and 0718T (ADRC therapy for rotator cuff tears), and HCPCS G0460 and G0465 (autologous PRP for chronic wounds). The breadth of this CPB 0784 Aetna policy update is significant — over 30 distinct indications are explicitly named as non-covered.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Blood and Adipose Tissue Derived Products for Selected Indications
Policy Code	CPB 0784
Change Type	Modified
Effective Date	November 21, 2025
Impact Level	High
Specialties Affected	Orthopedics, pain management, wound care, plastic surgery, ENT, gastroenterology, dermatology, OB/GYN
Key Action	Audit open authorizations and pending claims for all PRP, autologous blood, and adipose-derived therapy codes before billing against Aetna plans

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Aetna Blood and Adipose Tissue Products Coverage Criteria and Medical Necessity Requirements 2025

Here's the blunt truth about this coverage policy: there are no covered indications.

CPB 0784 is a blanket non-coverage policy. Aetna treats every blood product and adipose tissue procedure in this bulletin as experimental, investigational, or unproven. That determination applies regardless of clinical circumstances, provider documentation, or medical necessity arguments.

This matters for prior authorization, too. Even if your team secures a prior auth for one of these procedures, Aetna's published position is that none of them meet medical necessity standards. A prior auth here does not guarantee reimbursement — and it almost certainly won't survive a post-payment audit if Aetna's reviewers apply this CPB.

The Aetna PRP billing question your team keeps asking? The answer is in the policy: not covered, for any indication, including osteoarthritis, plantar fasciitis, rotator cuff injuries, and chronic wounds.

If your practice bills Aetna plans for any of these procedures, the effective date of November 21, 2025 is the line. Claims submitted after that date face an elevated denial risk if Aetna reviewers apply the updated CPB 0784.

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Aetna Blood and Adipose Tissue Products Exclusions and Non-Covered Indications

The scope of what Aetna excludes here is unusually wide. Most non-coverage policies target a handful of indications. This one names over 30 — and explicitly notes its lists are "not all-inclusive."

Autologous blood injection is non-covered for all indications. The policy names cervical radiculopathy, chronic urticaria, lateral epicondylitis, lumbar radiculopathy, muscular injury, plantar fasciopathy, TMJ dislocation, and tendinopathies of the elbow, heel, knee, patella, and shoulder.

Platelet-rich plasma (PRP) and platelet-poor plasma injection get the same treatment. Aetna lists 30 specific indications — every major musculoskeletal, wound care, and aesthetic use case your team likely bills. That includes Achilles tendinopathy, knee and hip osteoarthritis, rotator cuff injuries, plantar fasciitis, alopecia areata, facial rejuvenation, chronic wounds, non-healing hand wounds, Crohn's-related perianal fistula, and anterior cruciate ligament surgery.

Adipose-derived therapies — including Habeo cell therapy, Lipogems (autologous ADRC), and autologous fat injection — are non-covered for all indications. CPT codes 0489T, 0490T, 0565T, 0566T, 0717T, and 0718T all fall in this bucket.

Platelet-rich fibrin is excluded for intra-bony defects in chronic periodontitis and rotator cuff tears. Platelet-rich gel (HCPCS G0460, G0465, P9020) for tympanoplasty and diabetic foot ulcers is also non-covered.

Bone marrow-derived procedures — including mesenchymal stromal cell administration for facet joint injections (CPT codes 0213T–0218T, 64490–64495), avascular necrosis, Crohn's disease, and osteoarthritis — are excluded under this policy.

Autologous interleukin-1 receptor antagonist blood products (CPT 0481T) for knee osteoarthritis are explicitly non-covered.

Blood products in plastic surgery — including platelet-rich plasma, platelet-rich fibrin, concentrated growth factor, platelet-poor plasma, and mesenchymal stromal cells — are excluded. This affects billing under CPT codes 15771, 15772, 15773, and 15774 when blood products are part of the procedure.

Stem cell therapy for perianal fistulae (CPT 0748T) is non-covered. So is stromal vascular fraction with PRP for treatment-refractory perianal fistula. HCPCS S9055 (Procuren or other growth factor preparation) is also excluded.

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Coverage Indications at a Glance

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Aetna Blood and Adipose Tissue Products Billing Guidelines and Action Items 2025

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Blood and Adipose Tissue Products Under CPB 0784

Not Covered / Experimental CPT Codes

Other CPT Codes Referenced in CPB 0784

Not Covered / Experimental HCPCS Codes

Key ICD-10-CM Diagnosis Codes Referenced in CPB 0784

Note: CPB 0784 includes 321 total ICD-10-CM codes. The table above reflects codes confirmed in the policy data. Review the full policy at Aetna CPB 0784 for the complete diagnosis code list.

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