Aetna Autologous Chondrocyte Implantation prior authorization requirements (2026)
What Aetna generally requires to approve Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112), for Commercial plans. Yes. Aetna generally requires prior authorization for Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112).
Medical-necessity criteria Aetna generally applies
Aetna (CPB 0247) considers autologous chondrocyte implantation medically necessary for a symptomatic, disabling full-thickness focal articular cartilage defect on a load-bearing surface of the femoral condyle (medial, lateral, or trochlear), down to but not through subchondral bone, when ALL of the following are met: failure of conservative therapy (minimum 6 weeks of physical therapy within the past year); age 15 or older with documented growth-plate closure (adults under 55); BMI 35 or less; and an able, cooperative candidate for post-operative weight-bearing and activity restrictions and completion of rehabilitation.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Autologous Chondrocyte Implantation. Confirm the covered diagnosis list against the current Aetna policy.
Commonly required documentation
- All medical records requested must be submitted
How to submit
- Method: portal
- Typical turnaround: about 3 days
Source
Summarized (not verbatim) from Aetna Clinical Policy Bulletin 0247, Autologous Chondrocyte Implantation. Source: View the source policy. Last verified 2026-06-13.
Frequently asked questions
Does Aetna require prior authorization for Autologous Chondrocyte Implantation?
Yes. Aetna generally requires prior authorization for Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112).
What does Aetna require to approve Autologous Chondrocyte Implantation?
Aetna (CPB 0247) considers autologous chondrocyte implantation medically necessary for a symptomatic, disabling full-thickness focal articular cartilage defect on a load-bearing surface of the femoral condyle (medial, lateral, or trochlear), down to but not through subchondral bone, when ALL of the following are met: failure of conservative therapy (minimum 6 weeks of physical therapy within the p… Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Aetna typically decides Autologous Chondrocyte Implantation requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Autologous Chondrocyte Implantation 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.