CommercialCoverageHigh impact
Endovascular Arterial and Venous Stent Procedures (CPB 0785, reviewed 2026-06-05)
Aetna·Vascular Surgery, Cardiology, Radiology +3 more·Medical Policy
Effective date
Jun 5, 2026
We identified it
Aug 13, 2026
Summary
Aetna updated its Clinical Policy Bulletin 0785 for endovascular arterial and venous stent procedures effective June 5, 2026. The policy clarifies medical necessity criteria for stent procedures across peripheral vascular, central venous, and visceral sites, with specific coverage for FDA-approved stents under defined clinical scenarios and explicit exclusions for experimental approaches like biodegradable stents and certain off-label applications. Billing teams must align claim submissions with the specific indications and device requirements outlined, particularly noting that prior authorization through EviCore by Evernorth Peripheral Vascular Intervention Clinical Guidelines is required.
Action Required
By June 5, 2026: Billing team must implement the following changes: (1) Update billing software and prior authorization workflows to require EviCore by Evernorth clinical guideline review for all stent procedures using CPT codes 37236, 37237, 37221, 37223, 37226, and 37227. (2) Flag CPT 0505T as non-covered for Aetna claims and ensure it is not billed for endovenous femoral-popliteal arterial revascularization. (3) Flag CPT 93668 as non-covered for PAD rehabilitation/prehabilitation and update encounter forms to prevent ordering. (4) Configure system rules to deny claims for experimental procedures including biodegradable stents, hybrid foot vein arterialization, primary tibial/infra-popliteal stenting, fibromuscular dysplasia renal artery stenting, DETOUR system, and LimFlow Stent Graft System. (5) Ensure provider documentation templates capture specific medical necessity criteria (e.g., aneurysm size ≥2.0 cm, high surgical risk, adequate vessel anatomy for popliteal aneurysms; failure of optimal medical therapy for renal artery stenosis). (6) Providers and clinical staff must verify device FDA approval status before procedure scheduling. (7) Update billing compliance training for coders to reference specific indications listed in the policy. Failure to implement prior authorization requirements will result in claim denials. Claims for non-covered procedures will be denied retroactively.