Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AetnaCommercial · Coverage · Medical Policy · Orthopedics, Sports Medicine, Pain ManagementMedium impact

Knee Arthroscopy / Osteoarthritis of the Knee (CPB 0673, reviewed 2026-02-19)

Effective date
Not stated in the notice
Identified
Aug 16, 2026

Summary

Aetna's clinical policy bulletin on knee arthroscopy and knee osteoarthritis considers arthroscopic knee surgery, partial meniscectomy, and meniscal repair medically necessary only when the member has significant symptoms, no more than mild osteoarthritis (Kellgren-Lawrence 0, 1, or 2, or modified Outerbridge 0, 1, or 2), radiologic confirmation of the pathology, and failed conservative therapy. Chondroplasty (29877) is integral to other arthroscopic knee procedures and cannot be approved as an isolated request for significant arthritis. Zilretta is considered not medically necessary, and arthroscopic lavage or debridement for knee pain only or severe osteoarthritis, radiofrequency ablation, subchondroplasty and other listed treatments for knee osteoarthritis are considered experimental, investigational, or unproven.

Get alerts when payers change rules like this one

We check Aetna and other payers every day and email you when a change matches your specialty and state.

Get Aetna alertsPolicy Monitoring is free. No card required.

What to do

Action · 8 steps
01Billing team: Before billing arthroscopic knee surgery (29874, 29880 to 29883), confirm the chart documents significant knee pain plus mechanical symptoms, no more than mild osteoarthritis (Kellgren-Lawrence 0, 1, or 2, or modified Outerbridge 0, 1, or 2), radiologic confirmation of the pathology (X-ray for loose bodies, MRI for meniscal tears and/or loose bodies), and failure of conservative therapy.
02Conservative therapy means at least 6 weeks of formal in-person physical therapy in the past year, confirmed by the PT notes or by the claims history, and the source waives this only when the knee is locked by a displaced bucket handle tear of the meniscus.
03Providers: when the surgeon disagrees with the official written report of complex imaging, the surgeon documents the disagreement, discusses it with the provider who issued the report, and obtains a written addendum to the official report.
04Do not bill chondroplasty (29877) as an isolated procedure for minor chondral lesions or significant knee arthritis, because it is integral to other arthroscopic knee procedures.
05Diagnostic knee arthroscopy (29870) is generally not covered and may be billed and covered only when the radiologically proven pathology is not confirmed at surgery.
06Codes 29880 and 29881 are not covered for medial or lateral meniscal root tears, and meniscal root repair is covered only for members with significant symptoms and no more than mild osteoarthritis.
07Meniscal repair should only be considered when the vascular supply to the torn portion is adequate and the meniscal tissue is not degenerated on imaging.
08Zilretta (J3304) is considered not medically necessary under this policy, and the source directs Medicare members to the Medicare Part B criteria.

Codes mentioned

298702987129874298752987629877298792988029881298822988327332273332061020611G0289J3300J3301J3304Q68.6M17.0M17.9M23.000M23.369M23.200M23.269M25.561M25.569M25.661M25.669S83.200AS83.289S

Original notice

Knee Arthroscopy / Osteoarthritis of the Knee (CPB 0673, reviewed 2026-02-19)
aetna.com · Always check the source before changing claims.
View original ↗

Related changes

See all Aetna changes →
Viscosupplementation (CPB 0179, reviewed 2026-09-02)MediumNo effective date · Medical PolicyMenaflex (CPB 0786, reviewed 2025-12-02)MediumNo effective date · Medical PolicyPhonophoresis (CPB 0210, reviewed 2026-03-27)MediumNo effective date · Medical PolicyOfficeLink Updates - November 2024 notices and reminders (PDF)HighEffective Jan 1, 2025 · NewsletterBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesOrthopedicsSports MedicinePain ManagementCode 29870Code 29871Code 29874Code 29875Code 29876Code 29877Code 29879Code 29880Code 29881Code 29882Code 29883Code 27332Code 27333Code 20610Code 20611Code G0289Code J3300Code J3301Code J3304Code Q68.6Code M17.0Code M17.9Code M23.000Code M23.369Code M23.200Code M23.269Code M25.561Code M25.569Code M25.661Code M25.669Code S83.200ACode S83.289S

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account