TL;DR: Aetna, a CVS Health company, modified CPB 0785 governing peripheral vascular stent coverage, effective January 14, 2026. Here's what billing teams need to know about coverage criteria, excluded procedures, and the CPT and HCPCS codes that determine reimbursement.
Aetna's CPB 0785 peripheral vascular stents coverage policy covers a wide range of arterial, venous, and visceral stent procedures. The January 14, 2026 update affects CPT codes 37236, 37237, 37238, 37239, 37248, and 37249—along with HCPCS codes C1874 through C1877, C2617, and C2625. If your practice bills for iliac, femoral, popliteal, subclavian, or venous stenting procedures under Aetna, this policy governs your claims.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Peripheral Vascular Stents |
| Policy Code | CPB 0785 |
| Change Type | Modified |
| Effective Date | January 14, 2026 |
| Impact Level | High |
| Specialties Affected | Vascular surgery, interventional radiology, interventional cardiology, nephrology (dialysis access), general surgery |
| Key Action | Audit all peripheral vascular stent claims against EviCore by Evernorth guidelines before submitting under CPT 37236–37239 or HCPCS C1874–C1877 |
Aetna Peripheral Vascular Stent Coverage Criteria and Medical Necessity Requirements 2026
Aetna's peripheral vascular stents coverage policy delegates the actual medical necessity criteria to EviCore by Evernorth Peripheral Vascular Intervention Clinical Guidelines. This is the most important structural fact about CPB 0785 in the Aetna system—the policy itself doesn't contain a self-contained checklist. It points elsewhere.
EviCore reviews its guidelines annually. But EviCore also reserves the right to change them without prior notice. Draft guidelines are posted 90 days before implementation. You need to monitor the EviCore portal directly, not just Aetna's CPB.
To access the current guidelines: go to evicore.com/provider/clinical-guidelines, select "Cardiovascular & Vascular Intervention," enter "EviCore by Evernorth" in the search bar, accept the terms, and scroll to "Peripheral Vascular Intervention Guidelines." Build that URL into your team's reference library now—before January 14, 2026.
Arterial Stenting: What Qualifies as Medically Necessary
Aetna covers arterial stenting using FDA-approved stents across several specific indications. Medical necessity depends on the vessel, the clinical situation, and whether stenting is being used as primary or salvage therapy.
Primary therapy is covered for:
| # | Covered Indication |
|---|---|
| 1 | Common iliac artery stenosis and occlusion |
| 2 | External iliac artery stenosis and occlusion |
| 3 | Chronic mesenteric ischemia |
| 4 | Subclavian artery stenosis causing symptomatic posterior cerebral or cerebellar ischemia (subclavian steal syndrome) in high surgical-risk patients |
| 5 | Subclavian artery stenosis causing symptomatic extremity ischemia, following percutaneous transluminal angioplasty |
| 6 | Aorto-iliac arterial lesions (primary or salvage) |
Salvage therapy is covered for:
| # | Covered Indication |
|---|---|
| 1 | Brachiocephalic arteries: subclavian steal syndrome, upper extremity claudication, ischemic rest pain, non-healing ulceration, and focal gangrene |
| 2 | Common and external iliac arteries after suboptimal or failed balloon dilation—defined as persistent translesional gradient, residual diameter stenosis greater than 50%, or flow-limiting dissection |
| 3 | Femoral, popliteal, and tibial arteries under the same failed balloon dilation criteria |
Popliteal artery aneurysm gets its own criteria set. Coverage requires all three of the following:
| # | Covered Indication |
|---|---|
| 1 | The aneurysm is symptomatic (painful, pulsatile, or with evidence of distal emboli) or measures 2.0 cm or greater on imaging—even if asymptomatic |
| 2 | Documentation supports high perioperative surgical risk |
| 3 | Imaging confirms at least 15 mm of normal artery proximal AND distal to the aneurysm |
Miss any of those three elements in documentation and you're looking at a claim denial. All three must appear in the medical record.
Venous and Visceral Stenting Coverage
This coverage policy extends beyond arteries. Aetna covers:
| # | Covered Indication |
|---|---|
| 1 | Balloon angioplasty and stenting for ilio-caval venous occlusion |
| 2 | Central venous stenting of the superior vena cava for SVC syndrome, post-radiation venous stenosis, or congenital stenosis—billed under CPT 37238 or 37239 |
| 3 | Peripheral venous stents for hemodialysis access graft or fistula stenosis, restenosis, or occlusion |
| 4 | May-Thurner syndrome (iliac vein compression) |
Hemodialysis access is explicitly listed. If your practice handles dialysis access procedures and bills Aetna, verify your documentation addresses stenosis, restenosis, or occlusion specifically. Vague documentation on dialysis access claims is a common prior authorization failure point.
Prior Authorization via EviCore
Prior authorization for peripheral vascular stent procedures under this Aetna coverage policy runs through EviCore. This means your team submits clinical documentation to EviCore—not directly to Aetna—for review. The EviCore criteria are what get applied to your prior auth request.
Build your prior auth workflow around EviCore's documentation requirements, not just Aetna's CPB language. If you're unsure how the EviCore criteria map to your specific patient population or procedure mix, talk to your compliance officer before the effective date.
Aetna Peripheral Vascular Stent Exclusions and Non-Covered Indications
Two CPT codes are explicitly not covered for the indications listed in CPB 0785.
CPT 0505T—endovenous femoral-popliteal arterial revascularization with transcatheter placement of intravascular stent—is excluded. This is a Category III code for a specific hybrid revascularization approach. If your interventional team performs this procedure, don't expect Aetna reimbursement under this policy.
CPT 93668—peripheral arterial disease (PAD) rehabilitation, per session, including prehabilitation—is also not covered for indications listed in CPB 0785. PAD rehab as a standalone service doesn't get coverage here.
HCPCS C1874 carries a specific exclusion note: the Atrium Medical iCast covered stent is not covered. If your cath lab uses iCast, document that distinction in your supply chain and charge capture process. Billing C1874 for an iCast device will produce a denial.
CPT 0620T—endovascular venous arterialization of tibial or peroneal vein with transcatheter placement of intravascular stent—appears in the policy under a "hybrid foot vein arterialization" category with no specific covered code. This is a billing gray zone. Don't assume coverage exists for this procedure without direct verification.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Common iliac artery stenosis/occlusion | Covered | 37221, +37223, C1876, C1877 | Primary therapy; prior auth via EviCore |
| External iliac artery stenosis/occlusion | Covered | 37221, +37223, C1876, C1877 | Primary therapy; prior auth via EviCore |
| Aorto-iliac arterial lesions | Covered | 37236, 37237 | Primary or salvage therapy |
| Femoral/popliteal/tibial artery (failed balloon dilation) | Covered | 37226, 37227, C1876, C1877 | Salvage only; must document failed PTA with specific failure criteria |
| Popliteal artery aneurysm | Covered | 37236 | All 3 criteria must be met; high surgical risk documentation required |
| Chronic mesenteric ischemia | Covered | 37236, 37237 | Primary therapy |
| Subclavian steal syndrome (high surgical risk) | Covered | 37236, 37237 | Primary therapy; symptomatic posterior cerebral/cerebellar ischemia |
| Subclavian artery stenosis — extremity ischemia | Covered | 37236, 37237 | Following percutaneous transluminal angioplasty |
| Brachiocephalic arteries (claudication, rest pain, ulceration, gangrene) | Covered | 37236, 37237 | Salvage therapy |
| Ilio-caval venous occlusion | Covered | 37238, 37239, 37248, 37249 | Balloon angioplasty and stenting |
| SVC syndrome / post-radiation venous stenosis / congenital stenosis | Covered | 37238 | Central venous stent of superior vena cava |
| Hemodialysis access graft/fistula — stenosis, restenosis, occlusion | Covered | 37238, 37239, C1874, C1875 | Peripheral venous stent; document specific pathology |
| May-Thurner syndrome | Covered | 37238, 37239 | Peripheral venous stent |
| Femoral-popliteal arterial revascularization (CPT 0505T) | Not Covered | 0505T | Explicitly excluded for indications in CPB 0785 |
| PAD rehabilitation | Not Covered | 93668 | Not covered for indications in CPB 0785 |
| Hybrid foot vein arterialization (tibial/peroneal) | Unassigned | 0620T | No specific covered code; verify before billing |
| Atrium Medical iCast covered stent | Not Covered | C1874 | Explicit device exclusion noted in policy |
Aetna Peripheral Vascular Stent Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Register for EviCore portal access now. The medical necessity criteria for CPB 0785 live at EviCore, not inside the Aetna CPB. Your team needs direct access before January 14, 2026. Go to evicore.com/provider/clinical-guidelines and bookmark the Peripheral Vascular Intervention Guidelines under Cardiovascular & Vascular Intervention. |
| 2 | Flag CPT 0505T and CPT 93668 in your charge capture system. Mark both codes as non-covered under Aetna CPB 0785. Any claim submitted with these codes for the indications listed in CPB 0785 will deny. Set a hard stop or warning in your billing software before January 14, 2026. |
| 3 | Add an iCast device flag to your HCPCS C1874 charge capture. C1874 covers coated/covered stents with delivery systems—but not the Atrium Medical iCast specifically. If your facility stocks and implants iCast, your billing team needs a process to catch this before claim submission. One denied claim for this is avoidable. Repeated denials are a documentation process failure. |
| 4 | Audit popliteal aneurysm records against all three required criteria. Document that the aneurysm is symptomatic or ≥2.0 cm, that the patient is high surgical risk, and that imaging confirms at least 15 mm of normal artery on both sides of the aneurysm. All three must be in the chart. If any element is missing, you won't survive a prior auth review or a post-payment audit. |
| 5 | Update your dialysis access documentation templates. Hemodialysis access graft and fistula stenting is covered—but the documentation must specify whether the indication is stenosis, restenosis, or occlusion. Generic documentation that doesn't match one of those three terms creates unnecessary claim denial risk. |
| 6 | Set a calendar alert for EviCore guideline updates. EviCore can update its criteria without prior notice. Draft guidelines post 90 days before implementation, but that only helps if someone on your team is watching. Assign a specific person to monitor the EviCore portal monthly. This isn't a one-time task. |
| 7 | Review CPT 0620T billing with your compliance officer. The policy lists CPT 0620T (endovascular venous arterialization) under a hybrid foot vein arterialization category with no specific covered code designation. That ambiguity is a compliance risk. Don't bill it under Aetna without guidance. Loop in your compliance officer or billing consultant before submitting any claims with 0620T under CPB 0785. |
| 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 Peripheral Vascular Stents Under CPB 0785
Covered CPT Codes — When Selection Criteria Are Met
| Code | Type | Description |
|---|---|---|
| 37236 | CPT | Transcatheter placement of an intravascular stent(s), except lower extremity artery(s) for occlusive disease |
| 37237 | CPT | Each additional artery (add-on to 37236) |
| 37238 | CPT | Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation, venous |
| 37239 | CPT | Each additional vein (add-on to 37238) |
| 37248 | CPT | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision, venous; initial vein |
| 37249 | CPT | Each additional vein (add-on to 37248) |
Not Covered CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0505T | CPT | Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent | Not covered for indications listed in CPB 0785 |
| 93668 | CPT | Peripheral arterial disease (PAD) rehabilitation, per session | Not covered for indications listed in CPB 0785 |
Other CPT Codes Related to CPB 0785
| Code | Type | Description |
|---|---|---|
| 37221 | CPT | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s) |
| +37223 | CPT | With transluminal stent placement(s), includes angioplasty within the same vessel, when performed (add-on) |
| 37226 | CPT | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) |
| 37227 | CPT | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), with open vascular procedure |
| 0620T | CPT | Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent (hybrid foot vein arterialization — no specific covered code designation) |
Covered HCPCS Codes — When Selection Criteria Are Met
| Code | Type | Description |
|---|---|---|
| C1874 | HCPCS | Stent, coated/covered, with delivery system — Note: Atrium Medical iCast is explicitly not covered |
| C1875 | HCPCS | Stent, coated/covered, without delivery system |
| C1876 | HCPCS | Stent, non-coated/non-covered, with delivery system (femoropopliteal artery disease) |
| C1877 | HCPCS | Stent, non-coated/non-covered, without delivery system (femoropopliteal artery disease) |
| C2617 | HCPCS | Stent, noncoronary, temporary, without delivery system |
| C2625 | HCPCS | Stent, noncoronary, temporary, with delivery system |
Other HCPCS Codes Related to CPB 0785
| Code | Type | Description |
|---|---|---|
| C1604 | HCPCS | Graft, transmural transvenous arterial bypass (implantable), with all delivery system components |
| C2623 | HCPCS | Catheter, transluminal angioplasty, drug-coated, non-laser |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| G45.8 | Other transient cerebral ischemic attacks and related syndromes |
| I70.0 | Atherosclerosis of aorta |
| I70.1 | Atherosclerosis of renal artery |
| I70.201–I70.203 | Unspecified atherosclerosis of native arteries of extremities, lower legs |
| I70.211–I70.213 | Atherosclerosis of native arteries with intermittent claudication, lower legs |
| I70.291–I70.293 | Other atherosclerosis of native arteries of extremities, lower legs |
| I70.92 | Chronic total occlusion of artery of the extremities |
| I71.0–I71.9 | Aortic aneurysm and dissection (multiple subcategories) |
| I72.3 | Aneurysm of iliac artery |
| I72.8 | Aneurysm of other specified arteries (including celiac artery pseudoaneurysm) |
| I73.0–I73.9 | Other peripheral vascular disease (multiple subcategories) |
| I74.0 | Embolism and thrombosis of abdominal aorta |
| I74.09 | Other arterial embolism and thrombosis of abdominal aorta (aorto-iliac occlusive disease) |
| I74.3 | Embolism and thrombosis of arteries of lower extremities |
| I74.5 | Embolism and thrombosis of iliac artery |
| I77.1 | Stricture of artery (tibial) |
| I80.0–I80.9 | Phlebitis and thrombophlebitis (multiple subcategories) |
| I87.1–I87.17 | Compression of vein / recurrent cephalic arch stenosis (multiple subcategories) |
The full ICD-10-CM list for CPB 0785 contains 185 codes. Your billing team should map the complete code set against your patient population. Access the full list at app.payerpolicy.org/p/aetna/0785.
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