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Intervertebral Disc Prostheses (CPB 0591, reviewed 2026-09-18)
Effective date
Not stated in the notice
Identified
Oct 6, 2026
Summary
Aetna's Clinical Policy Bulletin 0591 on Intervertebral Disc Prostheses (reviewed 2026-09-18) establishes medical necessity criteria for cervical and lumbar disc arthroplasty, including specific FDA-approved device names, age limitations, clinical criteria, and contraindications. The policy designates certain procedures and devices as experimental/investigational. No effective date change is stated; this appears to be a policy review without a new implementation date specified.
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What to do
Action · 8 steps
01Billing and clinical teams should verify current applicability of this policy review (last reviewed 2026-09-18) within their Aetna contracting documentation.
02Confirm whether this review resulted in updates to prior authorization workflows, device coverage lists, or clinical criteria enforcement in your billing system.
03Ensure prior authorization submissions for cervical disc arthroplasty include verification of FDA-approved device names (Bryan, Mobi-C, Prestige, PCM, ProDisc-C variants, Secure-C, Simplify, Synergy) and member age compliance.
04Confirm lumbar disc arthroplasty requests document all exclusionary imaging findings (spondylolisthesis >3mm, moderate central stenosis, scoliosis >11 degrees, etc.) and the six-month conservative management requirement.
05Flag requests for multiple non-contiguous levels, posterior approaches, or non-FDA-approved devices (M6-C, MOTUS, TOPS System, 3D bioprinting) as experimental and non-covered.
06For diabetic members, verify HbA1c <8% documentation within 3 months pre-surgery or document medical urgency exception.
07For members age 60+, require DEXA scan with T-score ≥-1.0 within past year for cervical procedures.
08Contact Aetna's prior authorization line to confirm whether this policy review introduced new requirements or modified existing coverage thresholds.
Original notice
Intervertebral Disc Prostheses (CPB 0591, reviewed 2026-09-18)
aetna.com · Always check the source before changing claims.