CommercialCoverageMedium impact
Nerve Grafting and Reconstruction: Selected Indications (CPB 0416, reviewed 2026-10-06)
Aetna·Plastic Surgery, Neurosurgery, Orthopedics +1 more·Medical Policy
We identified it
Oct 12, 2026
Summary
This is a policy review (not a change) of Aetna's nerve grafting and reconstruction coverage. The policy establishes that nerve allograft (Avance) is covered for short-to-medium sensory nerve gaps (≤30 mm) in the upper extremity, while nerve grafts for prostate cancer erectile dysfunction, motor nerve repair, long gaps, and collagen conduits remain experimental/non-covered. The policy was last reviewed on 2026-10-06 with no stated effective date for modifications.
Action Required
Verify current applicability of this policy with Aetna, as the source document shows a review date of 2026-10-06 but does not state an effective date for any coverage changes. Billing team should confirm: (1) whether nerve allograft (Avance) claims for upper extremity sensory nerve gaps ≤30 mm require prior authorization; (2) current denial protocols for non-covered indications including prostatectomy nerve grafts (CPT 55840, 55842, 55845, 55866), motor nerve repair, collagen conduits (C9352, C9353, C9355, C9361), intraoperative electrical stimulation (0882T, 0883T), and diaphragmatic paralysis reconstruction; (3) whether this policy supersedes any prior guidance. Document the confirmation date and update billing system templates accordingly to reflect coverage vs. non-covered designations before submitting claims under these codes.