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AetnaMedicare Advantage · Prior Auth · Surgery · OrthopedicsMedium impact

Knee Arthroplasty (CPB 0660, reviewed 2026-02-26)

Effective date
Not stated in the notice
Identified
Aug 18, 2026

Summary

Aetna's Clinical Policy Bulletin 0660 sets the medical necessity criteria for knee arthroplasty. Total knee arthroplasty is medically necessary for adult members with advanced knee joint disease from osteoarthritis, rheumatoid arthritis, avascular necrosis or post-traumatic arthritis, with pain and functional disability that interferes with ADLs, and with unsuccessful conservative therapy of 12 or 24 weeks depending on age and body mass index. Unicompartmental knee arthroplasty and revision or replacement of total knee arthroplasty are covered under listed criteria, while bicompartmental and staged bicompartmental arthroplasty, customized total or partial knee implants, custom instrumentation including cutting blocks, and computer-assisted surgical navigation such as MAKOplasty are listed as experimental, investigational, or unproven for knee arthroplasty.

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What to do

Action · 10 steps
01Claims for total knee arthroplasty need documentation in the medical record of pain and functional disability that interferes with ADLs, limited range of motion, crepitus or effusion or swelling on physical examination, and radiographic evidence of moderate or severe osteoarthritis (Kellgren-Lawrence Grade 3 or 4), avascular necrosis, or rheumatoid arthritis.
02Documentation must show that all other reasonable sources of pain were ruled out and that unsuccessful conservative therapy of at least 12 weeks was addressed in the medical record (at least 24 weeks for members with a relative contraindication to joint replacement, such as morbid obesity with BMI greater than 40 or age less than 50 years).
03At least half of the conservative therapy must be formal in-person physical therapy with a licensed physical therapist in the past year, confirmed by actual PT notes or by documentation in the member claims history.
04The conservative therapy must include anti-inflammatory medications or analgesics, flexibility and muscle strengthening exercises, activity modification, supervised physical therapy, assistive device use, and therapeutic knee injections, unless contraindicated.
05For diabetic members, hemoglobin A1C should be less than 8 percent within 3 months before knee arthroplasty.
06Documentation must show that none of the absolute contraindications apply, including active joint infection, active skin infection or open wound at the surgical site, corticosteroid injection into the joint within 12 weeks of the planned arthroplasty, or allergy to implant components.
07Revision of total knee arthroplasty requires pain and functional disability with imaging-confirmed aseptic loosening, component fracture, confirmed periprosthetic infection, or another listed indication.
08Precertification may be required for select procedures, and the payer's CPT code search tool shows whether it applies.
09Robotic assistance is considered integral to the primary procedure and is not separately reimbursed.
10Intra-operative use of a kinetic balance sensor is considered incidental and is not separately reimbursed.

Codes mentioned

2744727446274372743827486274872748827440274412744227443209856462464625C1776S2900M17.0M17.9

Original notice

Knee Arthroplasty (CPB 0660, reviewed 2026-02-26)
aetna.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Aetna policiesOrthopedicsCode 27447Code 27446Code 27437Code 27438Code 27486Code 27487Code 27488Code 27440Code 27441Code 27442Code 27443Code 20985Code 64624Code 64625Code C1776Code S2900Code M17.0Code M17.9

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