50695 Insurance Policy Changes

Drug-Eluting Stents (CPB 0621, reviewed 2026-09-23)

This is a comprehensive Aetna clinical policy bulletin on drug-eluting stents (CPB 0621) reviewed on September 23, 2026. The policy defines covered indications for FDA-approved drug-eluting stents (everolimus, paclitaxel, sirolimus, zotarolimus, and ridaforolimus-eluting) for coronary and peripheral arterial disease, while classifying biodegradable polymer stents, antibody-coated stents, and drug-eluting stents for non-standard indications as experimental/investigational. Billing teams must ensure claims align with specific medical necessity criteria for stenosis thresholds and patient conditions.