Payor
Aetna Medicare Advantage
Rubrica tracks 306 sourced coverage rules across 306 CPT codes for Aetna Medicare Advantage — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicare Advantage, medicare_advantage. National policy.
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Every Rubrica record cites a specific Aetna Medicare Advantage policy document with last-reviewed date and (where available) verbatim source text. Aggregate coverage breakdown by procedure category is shown below; full payor-specific criteria require sign-in.
Coverage by category
Aetna Medicare Advantage's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Decompression — Surgical | 28 | 28 | 28 | 0 |
| Arthroscopy — Knee | 15 | 15 | 15 | 0 |
| Diagnostic | 14 | 14 | 10 | 0 |
| Vertebral Augmentation | 14 | 14 | 14 | 0 |
| Arthroscopy — Shoulder | 13 | 13 | 13 | 0 |
| Foot / Ankle | 13 | 13 | 13 | 0 |
| Hand / Upper Extremity | 10 | 10 | 10 | 0 |
| Spinal Instrumentation | 9 | 9 | 9 | 0 |
| Trauma — Lower Extremity | 9 | 9 | 9 | 0 |
| HCPCS Drug — Viscosupplementation | 8 | 8 | 8 | 0 |
| Intradiscal | 8 | 8 | 8 | 5 |
| Trauma — Upper Extremity | 8 | 8 | 8 | 0 |
Top tracked procedures
First 15 CPT codes in the Aetna Medicare Advantage catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
27447 | Total Knee Arthroplasty | Covered |
27130 | Total Hip Arthroplasty | Covered |
23472 | Total Shoulder Arthroplasty | Covered |
29827 | Arthroscopic Rotator Cuff Repair | Covered |
64721 | Open Carpal Tunnel Release | Covered |
22551 | ACDF | Covered |
22612 | PLF | Covered |
22558 | ALIF | Covered |
63030 | Lumbar microdiscectomy | Covered |
63047 | Lumbar laminectomy | Covered |
0200T | Sacroplasty — Unilateral | Covered |
0201T | Sacroplasty — Bilateral | Covered |
0221T | Posterior Intrafacet Implant — Lumbar | Covered |
0232T | PRP — Platelet Rich Plasma Injection | Covered |
0275T | MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) | Covered |
0481T | Bone Marrow Aspirate Concentrate (BMAC) Injection | Covered |
0627T | ViaDisc / Disc Allograft — Lumbar (1st level) | Covered |
0628T | ViaDisc — Lumbar (additional level) | Covered |
0629T | ViaDisc / Disc Allograft — Cervical/Thoracic (1st level) | Covered |
0630T | ViaDisc — Cervical/Thoracic (add'l) | Covered |
0779T | Percutaneous Tenotomy / Ultrasonic Debridement | Covered |
11980 | Testopel (testosterone pellet implantation) | Covered |
20526 | Carpal Tunnel Injection | Covered |
20527 | Injection — Dupuytren Cord (Xiaflex) | Covered |
20552 | Trigger Point Injection — 1 or 2 muscles | Covered |
See every policy for Aetna Medicare Advantage.
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