Aetna · Clinical coverage policy

Aetna Drug-Eluting Stents coverage criteria

Aetna CPB 0621 covers FDA-approved coronary drug-eluting stents (everolimus, paclitaxel, sirolimus, zotarolimus, ridaforolimus brands) for members with acute coronary syndrome, stable angina, or silent ischemia who can tolerate antiplatelet/anticoagulant therapy and have left-main stenosis >=50%, optimal-medical-therapy-refractory angina with >=70% stenosis, or such angina with >50% stenosis and FFR <=0.80; in-stent restenosis and Kawasaki coronary lesions are also covered, as are the Eluvia (SFA/proximal popliteal) and Zilver PTX (femoro-popliteal) peripheral stents. Bioresorbable/antibody-coated stents, Eluvia for iliac disease, and drug-eluting stents for all other (e.g., biliary, renal, carotid, intracranial, esophageal, dialysis-access) indications are experimental/investigational and not covered. The bulletin does not state any precertification or prior-authorization requirement.

Policy CPB 0621 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0621

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0621 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Drug-Eluting Stents (CPT 92928), and what gets it denied?

Path
Aetna CPB 0621 covers FDA-approved coronary drug-eluting stents (everolimus, paclitaxel, sirolimus, zotarolimus, ridaforolimus brands) for members with acute coronary syndrome, stable angina, or silent ischemia who can tolerate antiplatelet/anticoagulant therapy and have left-main stenosis >=50%, optimal-medical-therapy-refractory angina with >=70% stenosis, or such angina with >50% stenosis and FFR <=0.80; in-stent restenosis and Kawasaki coronary lesions are also covered, as are the Eluvia (SFA/proximal popliteal) and Zilver PTX (femoro-popliteal) peripheral stents. Bioresorbable/antibody-coated stents, Eluvia for iliac disease, and drug-eluting stents for all other (e.g., biliary, renal, carotid, intracranial, esophageal, dialysis-access) indications are experimental/investigational and not covered. The bulletin does not state any precertification or prior-authorization requirement. Coverage criteria include: FDA-approved everolimus-eluting stents (e.g., Promus Element Plus, Synergy, Xience Alpine/Prime/Xpedition/V), paclitaxel-eluting stents (e.g., Taxus Express), sirolimus-eluting stents (e.g., Agent), zotarolimus-eluting stents (e.g., Endeavor, Resolute Integrity, Resolute Onyx), and ridaforolimus-eluting stents (e.g., EluNIR) are medically necessary for members with acute coronary syndrome, angina pectoris (stable ischemic heart disease), or silent ischemia who are able to tolerate anti-platelet or anti-coagulant therapy AND who meet ANY ONE of the following: (1) coronary artery stenosis >=50% in left main coronary artery; OR (2) angina pectoris refractory/contraindicated/intolerant to optimal medical therapy with >=70% stenosis in 1 or more coronary arteries; OR (3) angina pectoris refractory/contraindicated/intolerant to optimal medical therapy with coronary artery stenosis >50% and fractional flow reserve (FFR) <=0.80; Coronary criterion (ONE of): coronary artery stenosis >=50% in the LEFT MAIN coronary artery; Coronary criterion (ONE of): angina pectoris that is refractory, contraindicated, or intolerant to optimal medical therapy AND has >=70% stenosis in 1 or more coronary arteries; Coronary criterion (ONE of): angina pectoris that is refractory, contraindicated, or intolerant to optimal medical therapy AND has coronary artery stenosis >50% with fractional flow reserve (FFR) <=0.80; Gate applying to all coronary indications: member must be able to tolerate anti-platelet OR anti-coagulant therapy, AND have acute coronary syndrome, angina pectoris (stable ischemic heart disease), or silent ischemia; FDA-approved drug-eluting stents are medically necessary for the treatment of intra-coronary stent re-stenosis (in-stent restenosis); FDA-approved drug-eluting stents are medically necessary for the treatment of coronary lesions in Kawasaki disease; The Eluvia Drug-Eluting Vascular Stent System is medically necessary for the primary treatment of superficial femoral artery (SFA) and proximal popliteal artery diseases; The Zilver PTX Drug-Eluting Peripheral Stent is medically necessary for the primary treatment of femoro-popliteal artery disease. Applies to 9 codes: 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Antibody coated coronary stents are considered experimental, investigational, or unproven (effectiveness not established); Biodegradable (bioresorbable, bioabsorbable, and magnetically-coated bioabsorbable) polymer drug-eluting stents are considered experimental, investigational, or unproven; Drug-eluting stents for the treatment of all other indications are considered experimental, investigational, or unproven, including (not an all-inclusive list) the items that follow; Drug-eluting stents for aorto-arteritis (Takayasu arteritis) - experimental/investigational/unproven; Drug-eluting stents for arteriovenous graft outflow vein stenosis in persons undergoing hemodialysis - experimental/investigational/unproven; Drug-eluting stents for chronic kidney disease with multi-vessel disease - experimental/investigational/unproven; Drug-eluting stents for coronary artery aneurysms - experimental/investigational/unproven; Drug-eluting stents for esophageal stricture, dysphagia (benign or malignant) - experimental/investigational/unproven; Drug-eluting stents for gastric outlet obstruction - experimental/investigational/unproven; Drug-eluting stents for intracranial atherosclerotic stenosis - experimental/investigational/unproven; Drug-eluting stents for myocardial bridging of coronary arteries - experimental/investigational/unproven; Drug-eluting stents for pancreato-biliary diseases including bile duct obstruction and endoscopic retrograde cholangiopancreatography (ERCP) - experimental/investigational/unproven; Drug-eluting stents for pulmonary vein stenosis - experimental/investigational/unproven; Drug-eluting stents for renal artery aneurysm - experimental/investigational/unproven; Drug-eluting stents for stenotic lesions of non-coronary arteries (carotid, peripheral vascular disease, renal artery, vertebral artery stenosis) - experimental/investigational/unproven; Drug-eluting stents for vein graft stenosis - experimental/investigational/unproven; Drug-eluting stents for venous stenosis associated with dialysis vascular access - experimental/investigational/unproven; The Eluvia Drug-Eluting Vascular Stent System for the treatment of iliac artery stenosis is NOT covered (this device-indication combination is not medically necessary; Eluvia is covered only for SFA/proximal popliteal disease); Contraindication / non-coverage: coronary artery stenting (regardless of stent type) is contraindicated in individuals who cannot receive recommended antiplatelet and/or anticoagulant therapy; Contraindication / non-coverage: coronary artery stenting (regardless of stent type) is contraindicated in individuals with lesions that prevent complete balloon inflation or proper placement of the stent or delivery device; Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to everolimus, paclitaxel, sirolimus, zotarolimus, ridaforolimus, or structurally-related compounds; Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to device materials or structurally-related compounds (acrylic, cobalt, chromium, fluoropolymers, nickel, platinum, stainless steel, tungsten); Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to the polymer, its components, or structurally-related compounds. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0621 — Drug-Eluting Stents

Coverage criteria

  • FDA-approved everolimus-eluting stents (e.g., Promus Element Plus, Synergy, Xience Alpine/Prime/Xpedition/V), paclitaxel-eluting stents (e.g., Taxus Express), sirolimus-eluting stents (e.g., Agent), zotarolimus-eluting stents (e.g., Endeavor, Resolute Integrity, Resolute Onyx), and ridaforolimus-eluting stents (e.g., EluNIR) are medically necessary for members with acute coronary syndrome, angina pectoris (stable ischemic heart disease), or silent ischemia who are able to tolerate anti-platelet or anti-coagulant therapy AND who meet ANY ONE of the following: (1) coronary artery stenosis >=50% in left main coronary artery; OR (2) angina pectoris refractory/contraindicated/intolerant to optimal medical therapy with >=70% stenosis in 1 or more coronary arteries; OR (3) angina pectoris refractory/contraindicated/intolerant to optimal medical therapy with coronary artery stenosis >50% and fractional flow reserve (FFR) <=0.80
  • Coronary criterion (ONE of): coronary artery stenosis >=50% in the LEFT MAIN coronary artery
  • Coronary criterion (ONE of): angina pectoris that is refractory, contraindicated, or intolerant to optimal medical therapy AND has >=70% stenosis in 1 or more coronary arteries
  • Coronary criterion (ONE of): angina pectoris that is refractory, contraindicated, or intolerant to optimal medical therapy AND has coronary artery stenosis >50% with fractional flow reserve (FFR) <=0.80
  • Gate applying to all coronary indications: member must be able to tolerate anti-platelet OR anti-coagulant therapy, AND have acute coronary syndrome, angina pectoris (stable ischemic heart disease), or silent ischemia
  • FDA-approved drug-eluting stents are medically necessary for the treatment of intra-coronary stent re-stenosis (in-stent restenosis)
  • FDA-approved drug-eluting stents are medically necessary for the treatment of coronary lesions in Kawasaki disease
  • The Eluvia Drug-Eluting Vascular Stent System is medically necessary for the primary treatment of superficial femoral artery (SFA) and proximal popliteal artery diseases
  • The Zilver PTX Drug-Eluting Peripheral Stent is medically necessary for the primary treatment of femoro-popliteal artery disease

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Drug-Eluting Stents (CPT 92928), and what gets it denied?
Aetna CPB 0621 covers FDA-approved coronary drug-eluting stents (everolimus, paclitaxel, sirolimus, zotarolimus, ridaforolimus brands) for members with acute coronary syndrome, stable angina, or silent ischemia who can tolerate antiplatelet/anticoagulant therapy and have left-main stenosis >=50%, optimal-medical-therapy-refractory angina with >=70% stenosis, or such angina with >50% stenosis and FFR <=0.80; in-stent restenosis and Kawasaki coronary lesions are also covered, as are the Eluvia (SFA/proximal popliteal) and Zilver PTX (femoro-popliteal) peripheral stents. Bioresorbable/antibody-coated stents, Eluvia for iliac disease, and drug-eluting stents for all other (e.g., biliary, renal, carotid, intracranial, esophageal, dialysis-access) indications are experimental/investigational and not covered. The bulletin does not state any precertification or prior-authorization requirement. Coverage criteria include: FDA-approved everolimus-eluting stents (e.g., Promus Element Plus, Synergy, Xience Alpine/Prime/Xpedition/V), paclitaxel-eluting stents (e.g., Taxus Express), sirolimus-eluting stents (e.g., Agent), zotarolimus-eluting stents (e.g., Endeavor, Resolute Integrity, Resolute Onyx), and ridaforolimus-eluting stents (e.g., EluNIR) are medically necessary for members with acute coronary syndrome, angina pectoris (stable ischemic heart disease), or silent ischemia who are able to tolerate anti-platelet or anti-coagulant therapy AND who meet ANY ONE of the following: (1) coronary artery stenosis >=50% in left main coronary artery; OR (2) angina pectoris refractory/contraindicated/intolerant to optimal medical therapy with >=70% stenosis in 1 or more coronary arteries; OR (3) angina pectoris refractory/contraindicated/intolerant to optimal medical therapy with coronary artery stenosis >50% and fractional flow reserve (FFR) <=0.80; Coronary criterion (ONE of): coronary artery stenosis >=50% in the LEFT MAIN coronary artery; Coronary criterion (ONE of): angina pectoris that is refractory, contraindicated, or intolerant to optimal medical therapy AND has >=70% stenosis in 1 or more coronary arteries; Coronary criterion (ONE of): angina pectoris that is refractory, contraindicated, or intolerant to optimal medical therapy AND has coronary artery stenosis >50% with fractional flow reserve (FFR) <=0.80; Gate applying to all coronary indications: member must be able to tolerate anti-platelet OR anti-coagulant therapy, AND have acute coronary syndrome, angina pectoris (stable ischemic heart disease), or silent ischemia; FDA-approved drug-eluting stents are medically necessary for the treatment of intra-coronary stent re-stenosis (in-stent restenosis); FDA-approved drug-eluting stents are medically necessary for the treatment of coronary lesions in Kawasaki disease; The Eluvia Drug-Eluting Vascular Stent System is medically necessary for the primary treatment of superficial femoral artery (SFA) and proximal popliteal artery diseases; The Zilver PTX Drug-Eluting Peripheral Stent is medically necessary for the primary treatment of femoro-popliteal artery disease. Applies to 9 codes: 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Antibody coated coronary stents are considered experimental, investigational, or unproven (effectiveness not established); Biodegradable (bioresorbable, bioabsorbable, and magnetically-coated bioabsorbable) polymer drug-eluting stents are considered experimental, investigational, or unproven; Drug-eluting stents for the treatment of all other indications are considered experimental, investigational, or unproven, including (not an all-inclusive list) the items that follow; Drug-eluting stents for aorto-arteritis (Takayasu arteritis) - experimental/investigational/unproven; Drug-eluting stents for arteriovenous graft outflow vein stenosis in persons undergoing hemodialysis - experimental/investigational/unproven; Drug-eluting stents for chronic kidney disease with multi-vessel disease - experimental/investigational/unproven; Drug-eluting stents for coronary artery aneurysms - experimental/investigational/unproven; Drug-eluting stents for esophageal stricture, dysphagia (benign or malignant) - experimental/investigational/unproven; Drug-eluting stents for gastric outlet obstruction - experimental/investigational/unproven; Drug-eluting stents for intracranial atherosclerotic stenosis - experimental/investigational/unproven; Drug-eluting stents for myocardial bridging of coronary arteries - experimental/investigational/unproven; Drug-eluting stents for pancreato-biliary diseases including bile duct obstruction and endoscopic retrograde cholangiopancreatography (ERCP) - experimental/investigational/unproven; Drug-eluting stents for pulmonary vein stenosis - experimental/investigational/unproven; Drug-eluting stents for renal artery aneurysm - experimental/investigational/unproven; Drug-eluting stents for stenotic lesions of non-coronary arteries (carotid, peripheral vascular disease, renal artery, vertebral artery stenosis) - experimental/investigational/unproven; Drug-eluting stents for vein graft stenosis - experimental/investigational/unproven; Drug-eluting stents for venous stenosis associated with dialysis vascular access - experimental/investigational/unproven; The Eluvia Drug-Eluting Vascular Stent System for the treatment of iliac artery stenosis is NOT covered (this device-indication combination is not medically necessary; Eluvia is covered only for SFA/proximal popliteal disease); Contraindication / non-coverage: coronary artery stenting (regardless of stent type) is contraindicated in individuals who cannot receive recommended antiplatelet and/or anticoagulant therapy; Contraindication / non-coverage: coronary artery stenting (regardless of stent type) is contraindicated in individuals with lesions that prevent complete balloon inflation or proper placement of the stent or delivery device; Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to everolimus, paclitaxel, sirolimus, zotarolimus, ridaforolimus, or structurally-related compounds; Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to device materials or structurally-related compounds (acrylic, cobalt, chromium, fluoropolymers, nickel, platinum, stainless steel, tungsten); Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to the polymer, its components, or structurally-related compounds. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Drug-Eluting Stents?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Drug-Eluting Stents?
Policy exclusions and limitations: Antibody coated coronary stents are considered experimental, investigational, or unproven (effectiveness not established); Biodegradable (bioresorbable, bioabsorbable, and magnetically-coated bioabsorbable) polymer drug-eluting stents are considered experimental, investigational, or unproven; Drug-eluting stents for the treatment of all other indications are considered experimental, investigational, or unproven, including (not an all-inclusive list) the items that follow; Drug-eluting stents for aorto-arteritis (Takayasu arteritis) - experimental/investigational/unproven; Drug-eluting stents for arteriovenous graft outflow vein stenosis in persons undergoing hemodialysis - experimental/investigational/unproven; Drug-eluting stents for chronic kidney disease with multi-vessel disease - experimental/investigational/unproven; Drug-eluting stents for coronary artery aneurysms - experimental/investigational/unproven; Drug-eluting stents for esophageal stricture, dysphagia (benign or malignant) - experimental/investigational/unproven; Drug-eluting stents for gastric outlet obstruction - experimental/investigational/unproven; Drug-eluting stents for intracranial atherosclerotic stenosis - experimental/investigational/unproven; Drug-eluting stents for myocardial bridging of coronary arteries - experimental/investigational/unproven; Drug-eluting stents for pancreato-biliary diseases including bile duct obstruction and endoscopic retrograde cholangiopancreatography (ERCP) - experimental/investigational/unproven; Drug-eluting stents for pulmonary vein stenosis - experimental/investigational/unproven; Drug-eluting stents for renal artery aneurysm - experimental/investigational/unproven; Drug-eluting stents for stenotic lesions of non-coronary arteries (carotid, peripheral vascular disease, renal artery, vertebral artery stenosis) - experimental/investigational/unproven; Drug-eluting stents for vein graft stenosis - experimental/investigational/unproven; Drug-eluting stents for venous stenosis associated with dialysis vascular access - experimental/investigational/unproven; The Eluvia Drug-Eluting Vascular Stent System for the treatment of iliac artery stenosis is NOT covered (this device-indication combination is not medically necessary; Eluvia is covered only for SFA/proximal popliteal disease); Contraindication / non-coverage: coronary artery stenting (regardless of stent type) is contraindicated in individuals who cannot receive recommended antiplatelet and/or anticoagulant therapy; Contraindication / non-coverage: coronary artery stenting (regardless of stent type) is contraindicated in individuals with lesions that prevent complete balloon inflation or proper placement of the stent or delivery device; Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to everolimus, paclitaxel, sirolimus, zotarolimus, ridaforolimus, or structurally-related compounds; Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to device materials or structurally-related compounds (acrylic, cobalt, chromium, fluoropolymers, nickel, platinum, stainless steel, tungsten); Contraindication: use of drug-eluting stents is contraindicated in individuals with known hypersensitivity to the polymer, its components, or structurally-related compounds. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0621 — Drug-Eluting Stents

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0621 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.