73620 Insurance Policy Changes

Bunionectomy (CPB 0629, reviewed 2025-12-11)

Aetna updated its bunionectomy clinical policy (CPB 0629) effective December 11, 2025, establishing specific medical necessity criteria for four procedure categories: simple bunionectomy, bony correction bunionectomy, first MTP joint surgical correction, bunionette correction, cheilectomy, and arthrodesis. The policy requires 6 months of documented conservative treatment, radiographic confirmation of specific angle measurements, skeletal maturity documentation, and symptom persistence before coverage. Billing teams must verify all four eligibility criteria are met and documented before claim submission to avoid denials.