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AetnaMedicare Advantage · Coverage · Surgery · OrthopedicsMedium impact

Knee Arthroplasty (CPB 0660, reviewed 2026-10-08)

Effective date
Not stated in the notice
Identified
Oct 13, 2026

Summary

Aetna's knee arthroplasty policy (CPB 0660) sets the criteria for total and unicompartmental knee replacement. Total knee arthroplasty is medically necessary for adult members with advanced joint disease, meaning pain and functional disability that interferes with ADLs, limited range of motion, crepitus or effusion, and moderate or severe knee osteoarthritis (Kellgren-Lawrence Grade 3 or 4) or another listed radiographic finding, after at least 12 weeks of documented non-surgical treatment (24 weeks for relative contraindications), with at least half of that treatment being formal in-person physical therapy in the past year. Revision of a total knee, unicompartmental arthroplasty and prophylactic tranexamic acid are covered under the listed criteria, while bicompartmental, customized, navigation-based and bacteriophage approaches are listed as experimental, investigational or unproven.

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What to do

Action · 9 steps
01Billing team: Before scheduling a knee arthroplasty, check whether precertification is required for the CPT code using the CPT code search tool the policy references, because precertification may be required for select procedures.
02Providers: Document in the medical record the pain and functional disability that interferes with ADLs, the limited range of motion, crepitus or effusion on exam, and the imaging findings that support the diagnosis.
03Document at least 12 weeks of non-surgical treatment (24 weeks for relative contraindications) that includes anti-inflammatory medications or analgesics, flexibility and muscle strengthening exercises, activity modification, supervised physical therapy, assistive device use and therapeutic knee injections, unless contraindicated.
04Confirm physical therapy with the actual PT notes or with the member's claims history.
05Check for absolute contraindications listed in the policy, such as an active joint infection, an active skin infection or open wound at the planned surgical site, or a corticosteroid injection into the joint within 12 weeks of the planned arthroplasty.
06For diabetic members, document an HbA1c below 8 percent within 3 months before the arthroplasty.
07For members with significant conditions or comorbidities, document the risk and benefit of the arthroplasty in the medical record.
08For revision procedures, document pain and functional disability that interferes with ADLs and confirm the indication by imaging, such as aseptic loosening, fracture or instability.
09Do not schedule or bill bicompartmental arthroplasty, customized implants, custom cutting blocks or computer-assisted navigation for knee arthroplasty, because their effectiveness has not been established.

Codes mentioned

2743727438274402744127442274432744627447274862748727488209856462464625C1776S2900M17.0M17.9M87.061M87.066I87.2L08.0L08.81L88M89.9M94.9

Original notice

Knee Arthroplasty (CPB 0660, reviewed 2026-10-08)
aetna.com · Always check the source before changing claims.
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Related changes

See all Aetna changes →
Knee Arthroplasty (CPB 0660, reviewed 2026-02-26)MediumNo effective date · SurgeryHip Arthroplasty (CPB 0287, reviewed 2026-09-23)MediumNo effective date · SurgeryHip Arthroplasty (CPB 0287, reviewed 2026-07-17)MediumNo effective date · SurgeryCryoanalgesia and Therapeutic Cold (CPB 0297, reviewed 2026-04-14)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesOrthopedicsCode 27437Code 27438Code 27440Code 27441Code 27442Code 27443Code 27446Code 27447Code 27486Code 27487Code 27488Code 20985Code 64624Code 64625Code C1776Code S2900Code M17.0Code M17.9Code M87.061Code M87.066Code I87.2Code L08.0Code L08.81Code L88Code M89.9Code M94.9

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