Aetna Bunionectomy (Hallux Valgus Correction) prior authorization requirements (2026)
What Aetna generally requires to approve Bunionectomy (Hallux Valgus Correction) (CPT 28292, 28296, 28297, 28298, 28299, 28290, 28294). Yes. Aetna generally requires prior authorization for Bunionectomy (Hallux Valgus Correction) (CPT 28292, 28296, 28297, 28298, 28299, 28290, 28294).
Medical-necessity criteria Aetna generally applies
Medically necessary by procedure type. SIMPLE bunionectomy: clinical symptoms plus at least 6 months of conservative treatment (footwear modifications, injections, orthotics, NSAIDs, protective pads) AND a hallux valgus angle (HVA) of 15 degrees or more, with no joint degeneration and documented skeletal maturity; OR, for members with diabetes, an ulcer and/or infection stemming solely from the bunion. BONY-CORRECTION bunionectomy: skeletally mature member (18 or older) with pain persisting despite at least a 6-month trial of conservative treatment, radiographic HVA of 30 degrees or greater AND intermetatarsal angle (IMA) of 12 degrees or greater, and at least one complication (neuroma, cross-over toe, limited first-MTP range of motion, ulceration, recurrent bursitis, or osteoarthritis).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Bunionectomy (Hallux Valgus Correction). Confirm the covered diagnosis list against the current Aetna policy.
Commonly required documentation
- Clinical symptoms
- documentation of at least 6 months of conservative treatment (footwear modifications, injections, orthotics, NSAIDs, protective pads)
- weight-bearing radiographs documenting HVA (and IMA for bony correction)
- skeletal-maturity documentation
- for the diabetic exception, ulcer/infection documentation.
Situations to verify before submitting
Aetna may not cover Bunionectomy (Hallux Valgus Correction) in these situations. Verify against the current policy rather than assuming a denial:
- Surgery to improve the appearance of the foot (cosmetic) is not medically necessary.
- Non-ambulatory patients (exceptions apply).
- Severe vascular insufficiency.
- Skin ulceration unrelated to the bunion.
Source
Source: Aetna Clinical Policy Bulletin 0629, Bunionectomy, last reviewed 12/11/2025 (). View the source policy. Last verified 2026-06-16.
Frequently asked questions
Does Aetna require prior authorization for Bunionectomy (Hallux Valgus Correction)?
Yes. Aetna generally requires prior authorization for Bunionectomy (Hallux Valgus Correction) (CPT 28292, 28296, 28297, 28298, 28299, 28290, 28294).
What does Aetna require to approve Bunionectomy (Hallux Valgus Correction)?
Medically necessary by procedure type. SIMPLE bunionectomy: clinical symptoms plus at least 6 months of conservative treatment (footwear modifications, injections, orthotics, NSAIDs, protective pads) AND a hallux valgus angle (HVA) of 15 degrees or more, with no joint degeneration and documented skeletal maturity; OR, for members with diabetes, an ulcer and/or infection stemming solely from the bu… 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 Bunionectomy (Hallux Valgus Correction) 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.