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Orthopedic Casts, Braces and Splints (CPB 0009, reviewed 2026-01-20)
Effective date
Not stated in the notice
Identified
Aug 12, 2026
Summary
Aetna considers orthoses, casts and splints medically necessary when they treat disease or injury for the listed indications, including lumbar and thoracic-lumbar-sacral braces that facilitate healing after a spine injury or spinal surgery, post-operative back braces applied within 6 weeks after spinal surgery, cervical braces for neck injury and torticollis, Unna boots for non-fracture care, air casts for fractures or other injuries, and prefabricated volar wrist braces for carpal tunnel syndrome. Prophylactic lumbar supports are considered experimental, investigational, or unproven, and elastic support garments and protective body socks do not meet Aetna's definition of covered durable medical equipment. Custom-fitted back braces are medically necessary where there is a failure, contraindication or intolerance to an unmodified, prefabricated back brace, and medical record documentation must support all coverage criteria because supplier-prepared statements and practitioner attestations alone are not sufficient.
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What to do
Action · 6 steps
01Billing team: for each new device or repair, confirm the treating practitioner has written a new prescription, because a new prescription is required each time a new device or repair is requisitioned, and confirm the Standard Written Order reached the supplier before the claim is submitted.
02The Standard Written Order must list the member's name or identification number, the order date, a general description of the item, each HCPCS code and quantity dispensed, the treating practitioner's name and national provider identifier, and the treating practitioner's signature, along with every concurrently ordered option, accessory or supply that is separately billed.
03Claims for an item billed without a completed Standard Written Order will be denied as not medically necessary.
04Billing team: keep sufficient information in the member's medical record to show that all applicable coverage criteria are met, and for custom fabricated orthoses keep detailed documentation in the supplier's records supporting the medical necessity of that type of device rather than a prefabricated orthosis.
05Bill HCPCS codes L1832, L1833, L1845, L1851 and L1852 only for products that have a written coding verification review published on the PDAC Product Classification List, and record the manufacturer, part number or part name in the medical records.
06Check the member's benefit plan description before billing DME, because standard Aetna HMO plans do not cover DME without a policy rider.
Codes mentioned
22548228122284022855630016305163170632006325063290290002958429580L0450L0454L0472L0488L0621L0623L0625L0628L0630L0631L0633L0635L0637L0639L0641L0642L0643L0648L0649L0650L0651L0452L0480L0482L0484L0486L0622L0624L0629L0632L0634L0636L0638L0640L0970L0999L1000L1499L0210L0220L2106L2192L3980L3995L4360L4361L4386L4387A4467E1800E1840L1600L2999L3650L4398L1690L1900L1990L2000L2038L0112L0113L0720L0120L0130L0200E1802E1805E1807E1808E1810E1813E1814E1822E1823E1825E1826E1827E1828E1829Q4049S8450S8452A4570Q4051Q4001A4580A4590L3908K0901K0902L1810L1812L1820L1830L1831L1832L1833L1834L1836L1840L1843L1844L1845L1846L1847L1848L1850L1851L1852L1860L2385L2390L2395L2397L2405L2415L2425L2430L2492L2755L2785L2795L2800L2810A18.01G90.1M08.1M25.78M62.830M67.88M40.00M41.9M43.20M43.28M43.6M46.1M46.40M48.38M48.8X1M48.9M49.80M53.1M53.2X7M53.2X8M53.3M54.09M54.2M54.9M81.0M81.8M96.1M96.5M99.10M99.15M99.20M99.79M99.83M99.84Q04.9Q07.9Q67.5Q76.0Q76.49S12.000AS12.9XXSS22.000AS22.089SS32.000AS32.2XXSS33.0XXAS33.39XSS34.01XAS34.4XXSZ46.89Z48.89F44.4F45.8G24.3M06.88P15.8Q68.0R29.891S10.0XXAS19.9XXSM24.851M24.859M24.151M24.159Q65.00Q65.9M96.2Q66.00Q68.5Q68.8Q79.9Q87.0M43.8X1M43.9E08.40E08.42E09.40E09.42E10.40E10.42E11.40E11.42E13.40E13.42G13.0G13.1G54.0G73.7M00.00M99.9S03.1XXAS03.1XXSS43.401AS43.92XSS46.011AS46.019SS53.20XAS53.499SS63.301AS63.92XSS66.011AS66.019SS93.401AS93.699SS96.011AS96.019SS96.111AS96.119SS96.211AS96.219SS96.811AS96.819SS96.911AS96.919SR68.89Z96.60Z96.698Z97.10Z97.16Z98.1G56.00G56.03
Original notice
Orthopedic Casts, Braces and Splints (CPB 0009, reviewed 2026-01-20)
aetna.com · Always check the source before changing claims.
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