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Total Ankle Arthroplasty (CPB 0645, reviewed 2026-09-14)
Effective date
Not stated in the notice
Identified
Oct 5, 2026
Summary
Aetna's Clinical Policy Bulletin 0645 covers total ankle arthroplasty with an FDA-cleared implant for severe ankle arthritis when a set of criteria is met, including at least 6 months of documented conservative care with in-person physical therapy, and covers revision for a failed prosthesis. It treats custom implants, trans-fibular replacement, total talar replacement and intraoperative infection frozen-section analysis as experimental. The source shows a review date of 2026-09-14 but states no effective date, and this is an older source first detected by PolicyChanges on 2026-10-05, so treat it as historical material.
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What to do
Action · 7 steps
01No effective date is stated, so this is historical material: confirm current applicability on Aetna's website before acting on it.
02If it still applies, Billing team and prior authorization staff: before scheduling total ankle arthroplasty (27702), confirm in the chart that the criteria are documented, including skeletal maturity, moderate or severe pain with loss of function, and imaging consistent with severe arthritis.
03Confirm at least 6 months of conservative care, including in-person physical therapy by a licensed therapist within the past year for at least 6 weeks (12 weeks if under 50 or BMI over 40), supported by PT notes or claims history.
04For diabetic members, confirm HbA1c is below 8 percent within 3 months before surgery.
05Providers: check the contraindications list, such as a corticosteroid injection into the joint within 12 weeks.
06Billing team: in charge entry, bill revision (27703) only for a failed prior ankle prosthesis, and do not bill custom implants, trans-fibular replacement or total talar replacement as covered.
07Check precertification requirements with the Aetna CPT code search tool before surgery, as the source says precertification may be required.
Codes mentioned
27702277038833188332M05.071M05.079M06.071M06.079M08.071M08.079M12.071M12.079M12.571M12.579M13.871M13.879M19.071M19.079M19.171M19.179M19.271M19.279Z98.1T84.018AT84.028AT84.038AT84.058AT84.068AE66.01E66.9A02.23A39.83A39.84A48.0A51.46A52.77B06.82I70.201I70.299I73.00I73.9I96L89.500L89.529L97.301L97.329M12.271M12.279M14.671M14.679M21.861M21.869M25.9R26.2Q68.6
Original notice
Total Ankle Arthroplasty (CPB 0645, reviewed 2026-09-14)
aetna.com · Always check the source before changing claims.
Related changes
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Related policy hubs
Aetna policiesOrthopedicsPodiatryCode 27702Code 27703Code 88331Code 88332Code M05.071Code M05.079Code M06.071Code M06.079Code M08.071Code M08.079Code M12.071Code M12.079Code M12.571Code M12.579Code M13.871Code M13.879Code M19.071Code M19.079Code M19.171Code M19.179Code M19.271Code M19.279Code Z98.1Code T84.018ACode T84.028ACode T84.038ACode T84.058ACode T84.068ACode E66.01Code E66.9Code A02.23Code A39.83Code A39.84Code A48.0Code A51.46Code A52.77Code B06.82Code I70.201Code I70.299Code I73.00Code I73.9Code I96Code L89.500Code L89.529Code L97.301Code L97.329Code M12.271Code M12.279Code M14.671Code M14.679Code M21.861Code M21.869Code M25.9Code R26.2Code Q68.6