Brachial Plexus Surgery (CPB 0850, reviewed 2025-12-18)

By 2025-12-18: Billing team must update claim submission and denial protocols in billing software to reflect Aetna's coverage determinations. (1) COVERED PROCEDURES: CPT 64713 (neuroplasty), 63170/64640 (DREZ coagulation), 64892-64898 and 64901-64907 (nerve grafting/transfer) are covered when medical necessity criteria are met—ensure these codes are NOT flagged for automatic denial. (2) NOT COVERED PROCEDURES: CPT 64912-64913 (nerve allograft repair), 20985 (computer-assisted navigation), and 29240 (therapeutic taping) must be flagged as non-covered for brachial plexus indications; implement automated denial rules with denial reason code referencing experimental/investigational status per CPB 0850. (3) Pre-authorization: Verify whether Aetna requires prior authorization for covered neuroplasty and nerve graft procedures; if required, update prior auth submission templates to include documentation of functional status and 3+ month waiting period for obstetric BPI cases. (4) Provider education: Alert orthopedic surgeons, neurosurgeons, and plastic surgeons in practice that bionic reconstruction, minimally invasive intercostal nerve harvesting, spinal accessory nerve transfer, and vascularized allo-transplantation will be denied as experimental. Claims submitted for these procedures will be denied; advise providers to discuss coverage limitations with patients preoperatively and obtain informed consent. Update encounter templates to document medical necessity for covered procedures and functional recovery status for obstetric BPI cases.