High impact
Knee Braces (CPB 1094, reviewed 20-2026-01)
Aetna·Effective Jan 20, 2026
Aetna has updated CPB 1094 on knee braces (DME) effective immediately, establishing comprehensive medical necessity criteria for orthopedic knee braces including prefabricated and custom-made options. The policy specifies strict documentation requirements (objective joint laxity testing, not subjective pain), provider qualifications, and conditions under which braces are considered medically necessary versus experimental. Billing teams must ensure claims meet all documented criteria or face denials.