CommercialCoverageHigh impact
Athletic Pubalgia Surgery (CPB 0750, reviewed 2025-12-02)
Aetna·Sports Medicine, General Surgery, Orthopedics·Surgery
Effective date
Dec 2, 2025
We identified it
Aug 14, 2026
Summary
Aetna's updated Clinical Policy Bulletin 0750 classifies surgical treatment for athletic pubalgia (including pelvic floor repair) as experimental, investigational, or unproven, along with intra-tissue percutaneous electrolysis and pulse-dose radiofrequency treatments. This means these procedures are not covered by Aetna and claims will be denied. The policy emphasizes that conservative treatment (rest, physical therapy, medications) should be attempted first, and provides specific ICD-10 codes for groin pain conditions.
Action Required
Effective immediately (12/02/2025): Billing team must deny or refuse to file all claims for surgical treatment of athletic pubalgia/sports hernia/core muscle injury (pelvic floor repair), intra-tissue percutaneous electrolysis, and pulse-dose radiofrequency procedures to Aetna. Update billing software and claim scrubbing rules to flag these procedures as non-covered (experimental/investigational). Providers must be notified that these surgeries will not be reimbursed by Aetna and patients should be counseled on conservative treatment options instead. For any claims already submitted or in-process, issue denial notifications citing CPB 0750. Update internal documentation and provider contracts to reflect non-coverage status.