Aetna ACL Reconstruction prior authorization requirements (2026)
What Aetna generally requires to approve ACL Reconstruction (CPT 29888, 29889), for Commercial plans. Prior authorization requirements vary by plan. Confirm with Aetna for ACL Reconstruction (CPT 29888, 29889).
Medical-necessity criteria Aetna generally applies
Aetna CPB 0364 (Allograft Transplants of the Extremities) addresses graft selection for ACL reconstruction rather than the underlying indication. Aetna considers allografts of the knee ligaments medically necessary as an alternative to autografts for knee-ligament reconstruction, but states there is inadequate evidence that tendon allograft is equally effective as autograft for primary isolated ACL reconstruction and that, due to disease-transmission risk, allograft should not be used for primary isolated ACL reconstruction. Allograft is supported for: (1) revision surgery where a prior autograft reconstruction failed; and (2) primary reconstruction of combined/multi-ligament injuries when an adequate autologous graft is not available.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for ACL Reconstruction. Confirm the covered diagnosis list against the current Aetna policy.
Related procedure codes
Codes often billed alongside ACL Reconstruction: 29888. Verify the correct codes for your documentation.
Commonly required documentation
- Operative indication and graft choice rationale
- for allograft, documentation of revision or multi-ligament injury / unavailable adequate autograft.
Situations to verify before submitting
Aetna may not cover ACL Reconstruction in these situations. Verify against the current policy rather than assuming a denial:
- Tendon allograft for primary isolated ACL reconstruction is not supported (disease-transmission risk; inadequate evidence of equivalence to autograft)
How to submit
- Method: Aetna precertification (Availity) - per member plan
- Portal: Availity
Source
Source: Aetna CPB 0364 Allograft Transplants of the Extremities. No standalone Aetna ACL-indication CPB located; CPB 0364 governs graft selection. Precertification for 29888 is governed by the member's plan precertification list (not stated in CPB 0364) - requires_prior_auth left null (varies). Last verified 2026-06-17.
Frequently asked questions
Does Aetna require prior authorization for ACL Reconstruction?
Prior authorization requirements vary by plan. Confirm with Aetna for ACL Reconstruction (CPT 29888, 29889).
What does Aetna require to approve ACL Reconstruction?
Aetna CPB 0364 (Allograft Transplants of the Extremities) addresses graft selection for ACL reconstruction rather than the underlying indication. Aetna considers allografts of the knee ligaments medically necessary as an alternative to autografts for knee-ligament reconstruction, but states there is inadequate evidence that tendon allograft is equally effective as autograft for primary isolated AC… Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Turnaround varies by plan and submission method. Check the Aetna portal for current timeframes.
Submitting ACL Reconstruction to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.