Prosthetic Limb Vacuum Systems (CPB 0630, reviewed 2026-01-21)
Aetna clinical policy bulletin 0630 covers vacuum and magnetic prosthetic socket systems. It considers the eVAC, the Harmony Vacuum Management System (VASS), and the LimbLogic VS Prosthetic Vacuum Suspension System medically necessary for use with lower limb prostheses when the prosthetic medical necessity criteria are met plus one listed criterion. It considers the use of magnetic panels to enlarge a trans-tibial prosthetic socket experimental, investigational, or unproven.