Medium impact
Winged Scapula (CPB 0859, reviewed 2025-12-09)
Aetna·Effective Dec 9, 2025
Aetna's updated Winged Scapula policy (CPB 0859) establishes medical necessity criteria for surgical muscle transfer procedures after failed conservative therapy (12 months for traumatic cases, 24 months for non-traumatic cases), while designating magnetic resonance neurography, long thoracic nerve neurolysis, and polyester tape scapulopexy as experimental/investigational and therefore non-covered. Billing teams must ensure proper code selection, apply appropriate medical necessity documentation requirements, and deny claims for experimental procedures.