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Intervertebral Disc Prostheses (CPB 0591, reviewed 2026-07-13)
Act
by Jul 13, 2026
Effective date
Jul 13, 2026
Identified
Aug 19, 2026
Summary
Aetna has updated its Intervertebral Disc Prostheses policy (CPB 0591) effective July 13, 2026, establishing specific medical necessity criteria for cervical and lumbar disc arthroplasty, including age limits, device-specific approvals, conservative treatment requirements, imaging specifications, and bone density/metabolic control standards. Billing teams must verify patient age, device type, clinical documentation, and pre-operative testing before submitting claims to avoid denials.
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What to do
by Jul 13, 2026 · 12 steps
01Billing team must implement the following verification steps BEFORE submitting disc arthroplasty claims.
02Verify patient age matches device-specific age limits (e.g., Mobi-C requires age 21-67 for cervical single level).
03Confirm imaging studies (MRI/CT) performed within past year document stenosis grade and rule out contraindications.
04Verify 6+ weeks recent conservative management documentation (PT notes, claims history within past year) or obtain waiver documentation for emergent conditions.
05For diabetic patients, confirm HbA1c <8% within 3 months prior to surgery (unless emergent: myelopathy, cauda equina, severe weakness 4-/5 or progressive weakness).
06For patients 60+, confirm DEXA scan (T-score ≥-1.0) within past year.
07For lumbar: confirm single-level disease at L3-4, L4-5, or L5-S1, age 18-60, VAS >5, and no contraindications (spondylolisthesis >3mm, stenosis, scoliosis >11°, fracture, infection, etc.).
08Attach all required documentation to pre-authorization request.
09Update Prior Auth checklist in billing system to require these fields before claim submission.
10Inform providers of new documentation requirements via encounter template updates.
11Claims submitted without verification will be denied.
12Designate Prior Auth specialist to review each case against policy criteria before authorization.
Original notice
Intervertebral Disc Prostheses (CPB 0591, reviewed 2026-07-13)
aetna.com · Always check the source before changing claims.