Elbow Arthroplasty (CPB 0857, reviewed 2025-12-09)

By December 9, 2025: (1) Billing team must update authorization protocols to deny coverage for any elbow arthroplasty procedures (CPT 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371) when corticosteroid injection into the joint has occurred within 12 weeks prior. (2) Update billing software to flag and reject claims for elbow hemiarthroplasty (experimental/investigational) and total elbow arthroplasty for osteoarthritis secondary to fracture (ICD-10 M19.221-M19.229) as non-covered services. (3) Providers must add screening question to pre-operative documentation: "Has corticosteroid injection been administered to the elbow joint in the past 12 weeks?" If yes, surgery cannot proceed. (4) Revise encounter forms and pre-authorization templates to include the new contraindication. (5) Train billing and pre-authorization staff on the three experimental/investigational procedures that now require denial. (6) Update system rules so claims for reconstructible comminuted radial head fractures using total elbow arthroplasty are automatically denied. Failure to implement these changes will result in inappropriate claim approval, subsequent denials from Aetna, and financial liability to the practice.