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Hip Preservation Surgery (CPB 0736, reviewed 2026-10-26)
Aetna·Orthopedics, Sports Medicine, General Surgery·Surgery
We identified it
Oct 27, 2026
Summary
Aetna's Hip Preservation Surgery policy (CPB 0736) was reviewed on 2026-10-26 but no effective date for changes is stated in the source document. This is a clinical policy bulletin that establishes medical necessity criteria for hip preservation procedures including femoro-acetabular surgery, hip arthroscopy, pelvic osteotomy, and related procedures. The policy specifies which procedures are covered, which require prior authorization based on strict clinical criteria, and which are considered experimental/investigational.
Action Required
Verify whether this is a new or updated policy by contacting Aetna directly, as the source document does not state a specific effective date for implementation. If this represents a current policy update: (1) Billing team should review all hip preservation surgery claims in process to ensure they meet Aetna's documented medical necessity criteria, including imaging requirements (X-rays, MRI, or CT showing labral pathology), 12 weeks of conservative treatment (6 weeks formal in-person physical therapy), and clinical exam findings. (2) Update prior authorization workflows to require documentation of: FAI diagnosis with specific imaging findings (alpha angle >50 degrees for cam impingement, center edge angle ≥40 degrees for pincer impingement), moderate-to-severe symptoms lasting ≥6 months, positive impingement signs, failure of conservative treatment, and absence of advanced osteoarthritis (Tonnis grade <2). (3) Implement billing system edits to prevent billing CPT 29862 (hip arthroscopy debridement) and CPT 29915 (acetabuloplasty) as standalone procedures when combined with FAI surgery codes 29914/29915/29916 or labrum repair code 29916, as these are considered integral and non-separately reimbursable. (4) Flag claims for CPT 29860 (diagnostic hip arthroscopy) as generally not covered unless intraoperative findings differ from pre-operative imaging. (5) Providers submitting hip preservation surgery requests must include comprehensive documentation per the medical necessity criteria noted above; claims lacking this documentation will be subject to denial.