Elbow Arthroplasty (CPB 0857, reviewed 2025-12-09)
This is Aetna's elbow arthroplasty policy was last reviewed 12/09/2025. Aetna considers total elbow arthroplasty medically necessary for an osteoporotic or non-amenable displaced intra-articular distal humerus fracture, for elbow pain unresponsive to medical therapy when radiographs show destruction of articular cartilage or gross deformity and the arm cannot be used for daily living because of pain, motion loss or instability, for elbow ankylosis after sepsis or trauma, and for salvage or revision of a failed implant. Arthroplasty with a metal radial head is considered medically necessary for an unreconstructible comminuted radial head fracture, and the policy notes that silicone implants are not resistant to wear.