Aetna Total Knee Arthroplasty prior authorization requirements (2026)
What Aetna generally requires to approve Total Knee Arthroplasty (CPT 27447), for Commercial plans. Yes. Aetna generally requires prior authorization for Total Knee Arthroplasty (CPT 27447).
Medical-necessity criteria Aetna generally applies
An FDA-approved total knee arthroplasty prosthesis is covered when the member has advanced joint disease shown by all of: pain and functional disability interfering with activities of daily living from osteoarthritis (or another qualifying arthropathy); limited range of motion, crepitus, or effusion/swelling of the knee on physical examination; AND radiographic evidence of moderate-to-severe osteoarthritis (Kellgren-Lawrence Grade 3 or 4). A history of unsuccessful conservative, non-surgical management is required (12 weeks, or 24 weeks depending on age and BMI).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Total Knee Arthroplasty. Confirm the covered diagnosis list against the current Aetna policy.
Source
Source: Aetna Clinical Policy Bulletin 0660 Knee Arthroplasty (www.aetna.com/cpb/medical/data/600_699/0660.html). Last verified 2026-06-11.
Frequently asked questions
Does Aetna require prior authorization for Total Knee Arthroplasty?
Yes. Aetna generally requires prior authorization for Total Knee Arthroplasty (CPT 27447).
What does Aetna require to approve Total Knee Arthroplasty?
An FDA-approved total knee arthroplasty prosthesis is covered when the member has advanced joint disease shown by all of: pain and functional disability interfering with activities of daily living from osteoarthritis (or another qualifying arthropathy); limited range of motion, crepitus, or effusion/swelling of the knee on physical examination; AND radiographic evidence of moderate-to-severe osteo… 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 Total Knee Arthroplasty 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.