CommercialCoverageMedium impact
Suit Therapy (CPB 0696, reviewed 2026-09-18)
Aetna·Pediatrics, Physical Therapy, Occupational Therapy +3 more·Medical Policy
We identified it
Oct 4, 2026
Summary
Aetna's Policy Bulletin 0696 (reviewed September 18, 2026) classifies suit therapy devices and related orthoses as experimental, investigational, or unproven for cerebral palsy, stroke rehabilitation, scoliosis, autism, and low trunk tone conditions. Billing teams must deny all claims for suit therapy, Dynamic Movement Orthoses, Benik dynamic trunk orthosis, and related devices when billed for these indications using the affected HCPCS and ICD-10 codes.
Action Required
Immediately: Billing team must update claim denial protocols in billing software to automatically deny all claims for suit therapy devices (including Adeli Suit, elastomeric tissue dynamic orthosis, Penguin Suit, Polish Suit, Therapy Suit, Therasuit, TheraTogs, Dynamic Lycra Suit, Dynamic Movement Orthosis, and Benik dynamic trunk orthosis) when billed with HCPCS codes A4467 or L1200, or any ICD-10 diagnosis codes F84.0-F84.9 (autism/pervasive developmental disorders), G80.0-G80.9 (cerebral palsy), G81.00-G81.94 (hemiplegia/hemiparesis), I69.00-I69.998 (stroke sequelae), or M40.00-M41.9 (scoliosis/kyphosis). Configure system to generate denial reason: 'Non-covered service - experimental/investigational per Aetna CPB 0696.' Notify all providers in writing that these devices are not covered for any indication. Update encounter templates and prior authorization workflows to prevent submission of these claims. Educate front desk and authorization staff that no prior authorization should be requested for these services, as they are categorically non-covered.