Intermittent Pneumatic Compression Devices | Aetna

Intermittent Pneumatic Compression Devices

Aetna · PayerPolicy · AETNA-CPB-0500

Status: Active
Effective: July 18, 2023
Last reviewed by Aetna: July 10, 2026
Last checked by Backwork: August 1, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.

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Codes in this policy

Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
E0675	HCPCS	Covered
E0676	HCPCS	Covered
G25.81	ICD10CM	Covered
M62.20	ICD10CM	Covered
M62.28	ICD10CM	Covered
N18.6	ICD10CM	Covered
T79.	ICD10CM	Covered
Z74.01	ICD10CM	Covered
Z86.73	ICD10CM	Covered