Joint Resurfacing (CPB 0661, reviewed 2026-10-07)

Verify current applicability of this policy with Aetna, as the source does not state an explicit effective date—only that it was reviewed on 2026-10-07. Billing and prior authorization teams should: (1) Confirm whether this CPB 0661 replaced or supersedes any previous joint resurfacing guidance; (2) Update authorization workflows to require documentation of all medically necessary criteria before approving hip resurfacing claims, including member age verification (under 65), advanced joint disease confirmation, failed 12-week conservative therapy with specific modalities (anti-inflammatory medications, physical therapy, weight reduction, injections where appropriate), and absence of contraindications (active infection, metal allergy, BMI >40, >50% femoral head involvement, etc.); (3) Flag claims for CPT 27125, 27130, or HCPCS S2118 for prior authorization review; (4) Deny or redirect claims for experimental indications (developmental dysplasia, metal-on-polyethylene implants, navigation-assisted procedures) unless member-specific clinical justification is documented; (5) For diabetic members, verify HbA1c <8% within 3 months prior to surgery; (6) Train providers and front-desk staff that incomplete conservative therapy documentation or missing contraindication screening will result in claim denial. Contact Aetna for confirmation of any recent updates to this policy, as discovery date (2026-10-11) differs from review date.