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AetnaAll Plans · Coverage · Medical Policy · Orthopedics, PediatricsMedium impact

Distraction Osteosynthesis (CPB 0220, reviewed 2026-04-09)

Effective date
Not stated in the notice
Identified
Aug 14, 2026

Summary

Aetna considers the Ilizarov method for distraction osteosynthesis medically necessary for members with an angular or rotational deformity of a long bone, a bone defect, or a limb length discrepancy who also meet one of the listed selection criteria, such as a leg length discrepancy of more than 4 cm, an arm length discrepancy of more than 5 cm, or a long bone fracture not healed in 6 or more months after electrical stimulation and bone grafting have failed. The PRECICE intramedullary limb lengthening system is considered medically necessary for lengthening the tibia and femur in persons with a leg length discrepancy of more than 4 cm. Ilizarov use for other indications, the intramedullary skeletal kinetic distractor, pulsed ultrasound as an adjuvant therapy, and Phenix nails are considered experimental, investigational or unproven, and Ilizarov use to correct short stature is considered cosmetic.

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What to do

Action · 6 steps
01Billing team: Before billing the Ilizarov method, confirm the member has one of the listed indications (angular or rotational deformity of a long bone, bone defect with or without deformity, or limb length discrepancy with or without deformity) and meets at least one listed selection criterion: a leg length discrepancy of more than 4 cm, an arm length discrepancy of more than 5 cm, a long bone fracture not healed in 6 or more months after electrical stimulation (CPB 0343) and bone grafting (CPB 0411) have failed, or an angular or rotational deformity with functional impairment after other treatments have failed.
02Femoral shortening is listed as an acceptable alternative treatment for lower extremity length discrepancies greater than 1 inch (2.5 cm) that limit function.
03Before billing PRECICE intramedullary lengthening of the tibia or femur, confirm the member has a leg length discrepancy of more than 4 cm.
04Use of the Ilizarov method outside the listed indications is considered experimental, investigational or unproven, and use of the Ilizarov method to correct short stature is considered cosmetic.
05CPT 20979 is not covered for the indications listed in the policy.
06Insertion of wires and the osteotomy are performed in the hospital, and removal of the device can be performed in the office or clinic, so hospitalization to remove the device is not necessary.

Codes mentioned

20690206922069320694206962069727458274652771320979E0747E0760G0283M21.751M21.769Q74.2E23.0E34.39R62.52

Original notice

Distraction Osteosynthesis (CPB 0220, reviewed 2026-04-09)
aetna.com · Always check the source before changing claims.
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Related changes

See all Aetna changes →
Cranial Remodeling (CPB 0379, reviewed 2026-05-26)MediumNo effective date · Medical PolicyDistraction Osteogenesis for Craniofacial Defects (CPB 0549, reviewed 2026-07-30)MediumNo effective date · Medical PolicyBone Growth Stimulators (CPB 0343, reviewed 2026-05-26)MediumNo effective date · Medical PolicyGrowth Hormone (GH) and Growth Hormone Antagonists (CPB 0170, reviewed 2026-06-26)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesOrthopedicsPediatricsCode 20690Code 20692Code 20693Code 20694Code 20696Code 20697Code 27458Code 27465Code 27713Code 20979Code E0747Code E0760Code G0283Code M21.751Code M21.769Code Q74.2Code E23.0Code E34.39Code R62.52

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