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.
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01Billing team: before billing CPT 24360 through 24371, confirm the chart documents one of the covered indications, such as an osteoporotic or non-amenable displaced intra-articular distal humerus fracture, salvage or revision of a failed implant, or elbow ankylosis after sepsis or trauma.
02Do not bill elbow hemiarthroplasty for humerus fractures, total elbow arthroplasty for reconstructible comminuted radial head fractures, or total elbow arthroplasty for osteoarthritis secondary to fracture, because the policy considers these experimental and investigational.
03Do not schedule or bill total elbow arthroplasty when a corticosteroid was injected into the joint within 12 weeks of the planned arthroplasty, because the policy considers it contraindicated and not medically necessary.
Summaries are AI-assisted. Always confirm against the original payer notice.
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