Aetna · Clinical coverage policy

Aetna Endovascular Repair of Aortic Aneurysms coverage criteria

Aetna CPB 0651 covers endovascular repair of aortic disease as medically necessary, including endovascular stent-graft repair of infra-renal abdominal aortic/aorto-iliac aneurysms (FDA-approved fenestrated, branched, or non-fenestrated grafts) and descending thoracic aortic aneurysms (FDA-approved endoprosthesis), plus FDA-approved stenting for aortic coarctation when the patient weighs at least 1.5 kg and has systemic hypertension with a resting arm-leg gradient over 20 mmHg, and endovascular treatment of pediatric pulmonary artery stenosis/hypoplasia. The key gate is use of an FDA-approved device for an approved indication; nine items (e.g., the Nellix sealing system, ascending-aorta and total aortic-arch endovascular repair, fabric wrapping, IMA pre-embolization, wireless pressure sensors) are considered experimental/investigational and are not covered.

Policy CPB 0651 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0651

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0651 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 Endovascular Repair of Aortic Aneurysms (CPT 34701), and what gets it denied?

Path
Aetna CPB 0651 covers endovascular repair of aortic disease as medically necessary, including endovascular stent-graft repair of infra-renal abdominal aortic/aorto-iliac aneurysms (FDA-approved fenestrated, branched, or non-fenestrated grafts) and descending thoracic aortic aneurysms (FDA-approved endoprosthesis), plus FDA-approved stenting for aortic coarctation when the patient weighs at least 1.5 kg and has systemic hypertension with a resting arm-leg gradient over 20 mmHg, and endovascular treatment of pediatric pulmonary artery stenosis/hypoplasia. The key gate is use of an FDA-approved device for an approved indication; nine items (e.g., the Nellix sealing system, ascending-aorta and total aortic-arch endovascular repair, fabric wrapping, IMA pre-embolization, wireless pressure sensors) are considered experimental/investigational and are not covered. Coverage criteria include: Endovascular repair of infra-renal abdominal aortic or aorto-iliac aneurysms with an FDA-approved fenestrated, branched, or non-fenestrated endovascular stent graft (the medically necessary list states no specific diameter threshold; size/growth thresholds such as >=5 cm, 4-5 cm with 0.5 cm growth in 6 months, or twice the normal aorta diameter appear only in the Background as context, not as formal policy criteria); Endovascular repair of descending thoracic aortic aneurysms with an FDA-approved endoprosthesis (no specific diameter/anatomic threshold stated in the medically necessary list); Endovascular stenting with an FDA-approved stent for the treatment of aortic coarctation in persons who meet ALL of the following: body weight of 1.5 kg (3.3 lbs) or more AND systemic arterial hypertension AND resting arm-leg pressure gradient greater than 20 mmHg; Endovascular treatment for pulmonary artery stenosis and/or hypoplasia in a child (pediatric patient); Surveillance studies following endovascular or open aortic surgery, performed per EviCore Peripheral Vascular Disease (PVD) Imaging Guidelines and EviCore Pediatric PVD Imaging Guidelines. Applies to 35 codes: 34701, 34702, 34703, 34704, 34705, 34706, 34707, 34708, 34710, 34712, 34713, 34714, 34716, 34718, 34808, 34812, 34820, 34833, 34834, 34839, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848, 33880, 33881, 33883, 33884, 33886, 33889, 33891.
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: Experimental/investigational/unproven: Bifurcated-bifurcated aneurysm repair of aorto-iliac aneurysms; Experimental/investigational/unproven: Endovascular Aneurysm Sealing System (Nellix device) for treatment of abdominal aortic aneurysms, including for failed endovascular aneurysm repairs; Experimental/investigational/unproven: Endovascular repair for non-dissected ascending aortic diseases; Experimental/investigational/unproven: Fabric/mesh wrapping of abdominal aortic aneurysms; Experimental/investigational/unproven: GORE EXCLUDER thoraco-abdominal branch endoprosthesis for thoraco-abdominal aortic aneurysms; Experimental/investigational/unproven: Implanted wireless pressure sensors for endoleak detection in the aneurysmal sac following endovascular repair; Experimental/investigational/unproven: Nectero Endovascular Aneurysm Stabilization Treatment (EAST) system; Experimental/investigational/unproven: Pre-operative embolization of the inferior mesenteric artery to reduce type II endoleak following endovascular abdominal aortic aneurysm repair; Experimental/investigational/unproven: Total endovascular aortic arch repair for aortic arch disease. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0651 — Endovascular Repair of Aortic Aneurysms

Coverage criteria

  • Endovascular repair of infra-renal abdominal aortic or aorto-iliac aneurysms with an FDA-approved fenestrated, branched, or non-fenestrated endovascular stent graft (the medically necessary list states no specific diameter threshold; size/growth thresholds such as >=5 cm, 4-5 cm with 0.5 cm growth in 6 months, or twice the normal aorta diameter appear only in the Background as context, not as formal policy criteria)
  • Endovascular repair of descending thoracic aortic aneurysms with an FDA-approved endoprosthesis (no specific diameter/anatomic threshold stated in the medically necessary list)
  • Endovascular stenting with an FDA-approved stent for the treatment of aortic coarctation in persons who meet ALL of the following: body weight of 1.5 kg (3.3 lbs) or more AND systemic arterial hypertension AND resting arm-leg pressure gradient greater than 20 mmHg
  • Endovascular treatment for pulmonary artery stenosis and/or hypoplasia in a child (pediatric patient)
  • Surveillance studies following endovascular or open aortic surgery, performed per EviCore Peripheral Vascular Disease (PVD) Imaging Guidelines and EviCore Pediatric PVD Imaging Guidelines

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 Endovascular Repair of Aortic Aneurysms (CPT 34701), and what gets it denied?
Aetna CPB 0651 covers endovascular repair of aortic disease as medically necessary, including endovascular stent-graft repair of infra-renal abdominal aortic/aorto-iliac aneurysms (FDA-approved fenestrated, branched, or non-fenestrated grafts) and descending thoracic aortic aneurysms (FDA-approved endoprosthesis), plus FDA-approved stenting for aortic coarctation when the patient weighs at least 1.5 kg and has systemic hypertension with a resting arm-leg gradient over 20 mmHg, and endovascular treatment of pediatric pulmonary artery stenosis/hypoplasia. The key gate is use of an FDA-approved device for an approved indication; nine items (e.g., the Nellix sealing system, ascending-aorta and total aortic-arch endovascular repair, fabric wrapping, IMA pre-embolization, wireless pressure sensors) are considered experimental/investigational and are not covered. Coverage criteria include: Endovascular repair of infra-renal abdominal aortic or aorto-iliac aneurysms with an FDA-approved fenestrated, branched, or non-fenestrated endovascular stent graft (the medically necessary list states no specific diameter threshold; size/growth thresholds such as >=5 cm, 4-5 cm with 0.5 cm growth in 6 months, or twice the normal aorta diameter appear only in the Background as context, not as formal policy criteria); Endovascular repair of descending thoracic aortic aneurysms with an FDA-approved endoprosthesis (no specific diameter/anatomic threshold stated in the medically necessary list); Endovascular stenting with an FDA-approved stent for the treatment of aortic coarctation in persons who meet ALL of the following: body weight of 1.5 kg (3.3 lbs) or more AND systemic arterial hypertension AND resting arm-leg pressure gradient greater than 20 mmHg; Endovascular treatment for pulmonary artery stenosis and/or hypoplasia in a child (pediatric patient); Surveillance studies following endovascular or open aortic surgery, performed per EviCore Peripheral Vascular Disease (PVD) Imaging Guidelines and EviCore Pediatric PVD Imaging Guidelines. Applies to 35 codes: 34701, 34702, 34703, 34704, 34705, 34706, 34707, 34708, 34710, 34712, 34713, 34714, 34716, 34718, 34808, 34812, 34820, 34833, 34834, 34839, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848, 33880, 33881, 33883, 33884, 33886, 33889, 33891. 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: Experimental/investigational/unproven: Bifurcated-bifurcated aneurysm repair of aorto-iliac aneurysms; Experimental/investigational/unproven: Endovascular Aneurysm Sealing System (Nellix device) for treatment of abdominal aortic aneurysms, including for failed endovascular aneurysm repairs; Experimental/investigational/unproven: Endovascular repair for non-dissected ascending aortic diseases; Experimental/investigational/unproven: Fabric/mesh wrapping of abdominal aortic aneurysms; Experimental/investigational/unproven: GORE EXCLUDER thoraco-abdominal branch endoprosthesis for thoraco-abdominal aortic aneurysms; Experimental/investigational/unproven: Implanted wireless pressure sensors for endoleak detection in the aneurysmal sac following endovascular repair; Experimental/investigational/unproven: Nectero Endovascular Aneurysm Stabilization Treatment (EAST) system; Experimental/investigational/unproven: Pre-operative embolization of the inferior mesenteric artery to reduce type II endoleak following endovascular abdominal aortic aneurysm repair; Experimental/investigational/unproven: Total endovascular aortic arch repair for aortic arch disease. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Endovascular Repair of Aortic Aneurysms?
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 Endovascular Repair of Aortic Aneurysms?
Policy exclusions and limitations: Experimental/investigational/unproven: Bifurcated-bifurcated aneurysm repair of aorto-iliac aneurysms; Experimental/investigational/unproven: Endovascular Aneurysm Sealing System (Nellix device) for treatment of abdominal aortic aneurysms, including for failed endovascular aneurysm repairs; Experimental/investigational/unproven: Endovascular repair for non-dissected ascending aortic diseases; Experimental/investigational/unproven: Fabric/mesh wrapping of abdominal aortic aneurysms; Experimental/investigational/unproven: GORE EXCLUDER thoraco-abdominal branch endoprosthesis for thoraco-abdominal aortic aneurysms; Experimental/investigational/unproven: Implanted wireless pressure sensors for endoleak detection in the aneurysmal sac following endovascular repair; Experimental/investigational/unproven: Nectero Endovascular Aneurysm Stabilization Treatment (EAST) system; Experimental/investigational/unproven: Pre-operative embolization of the inferior mesenteric artery to reduce type II endoleak following endovascular abdominal aortic aneurysm repair; Experimental/investigational/unproven: Total endovascular aortic arch repair for aortic arch disease. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0651 — Endovascular Repair of Aortic Aneurysms

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0651 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.