Inpatient Admission Prior to Surgery (Preop Days) (CPB 0255, reviewed 2026-05-13)
Aetna's updated Clinical Policy Bulletin 0255 (reviewed May 13, 2026) clarifies medical necessity criteria for inpatient hospital admission on the day(s) prior to surgery. The policy establishes specific clinical scenarios where preoperative hospitalization is covered, including pediatric cardiac procedures requiring hydration, high-risk bowel prep cases, brittle diabetes requiring glucose monitoring, fiducial placement for brain surgery, concurrent medical problems requiring inpatient treatment before major surgery, unstable cardiac patients undergoing open heart procedures, and cases requiring medications/fluids unavailable in outpatient settings. This requires billing teams to ensure prior authorization requests include documented medical necessity aligned with these specific criteria.