L7364 Insurance Policy Changes

Upper Limb Prostheses (CPB 0399, reviewed 2026-07-16)

Aetna updated its upper limb prosthetics policy (CPB 0399, effective 2026-07-16) clarifying medical necessity criteria, device coverage, and payment rules. Key changes include expanded coverage for myoelectric prostheses under specific conditions, explicit limitations on test sockets (max 2), replacement liners (max 2 per 12 months), and prosthetic sheaths (max 12 in 12 months), plus designation of multiple devices as experimental/investigational. The policy explicitly excludes cosmetic upgrades, sporting prosthetics, and water prosthetics, and clarifies that evaluation, measurement, casting, fitting, CAD-CAM fabrication, batteries, and chargers are included in base prosthesis reimbursement with no separate payment.