CommercialCoverageMedium impact
Electrical Stimulation for Chronic Ulcers (CPB 0680, reviewed 2025-12-29)
Aetna·Wound Care, Dermatology, Physical Therapy +3 more·Medical Policy
Effective date
Dec 29, 2025
We identified it
Aug 14, 2026
Summary
Aetna's electrical stimulation policy (CPB 0680) establishes strict medical necessity criteria for chronic ulcer treatment: therapy is covered only as adjunctive treatment after 30 days of failed conventional care for arterial, diabetic, Stage III/IV pressure, or venous stasis ulcers. Treatment is limited to 60 minutes per day for maximum 4 weeks, with continued therapy requiring measurable healing signs within 4 weeks. Home-based treatment and numerous combination therapies are not covered.
Action Required
By 2025-12-29: Billing team must implement the following changes in the billing system: (1) For CPT 97014, 97032, and HCPCS G0281, require documented evidence that patient completed at least 30 days of conventional wound care WITHOUT measurable healing before authorizing reimbursement. Update claim edits to deny these codes without this documentation. (2) Add system rules to flag and deny CPT 97035, E0745, and any claims for microcurrent/VeinoPlus devices as non-covered experimental treatments. (3) For all electrical stimulation claims, implement frequency limits: deny any claims exceeding 60 minutes per day or treatment duration beyond 4 weeks. (4) Require measurable healing documentation (wound size reduction, decreased exudate, decreased necrotic tissue) at 4-week mark; deny continuation beyond this point without evidence. (5) Deny all home-based electrical stimulation claims (G0281 in home setting). (6) Update encounter forms and provider education materials to clarify that only Stage III and IV pressure ulcers (not Stage I/II) qualify. Failure to implement these edits will result in improper claim payments and potential recovery actions. Providers must be notified of these requirements immediately.