20902 Insurance Policy Changes

Pectus Excavatum and Poland's Syndrome: Surgical Correction (CPB 0272, reviewed 2026-04-17)

Aetna updated its coverage policy (CPB 0272) for surgical correction of pectus excavatum and Poland's syndrome, effective April 17, 2026. The policy establishes specific medical necessity criteria including pectus index >3.25, documented functional deficits (cardiac compression or reduced lung capacity ≤80% TLC), and required diagnostic testing. Experimental procedures (Dynamic Compression System, magnetic mini-mover, vacuum bell) and cosmetic repairs are not covered. Billing teams must verify all criteria are met before processing claims for covered CPT codes 21740, 21742, 21743, and Poland's syndrome reconstruction codes.