Aetna modified CPB 0204 for manipulation under general anesthesia (MUA), effective September 26, 2025. Here's what billing teams need to know before claims go out the door.
Aetna, a CVS Health company, updated its MUA coverage policy under CPB 0204 to clarify which joint procedures qualify as medically necessary and which ones don't. The three covered indications are specific: arthrofibrosis of the knee (CPT 27570), chronic refractory frozen shoulder (CPT 23700), and temporomandibular joint disorders (CPT 21073). Everything else—hip manipulation (CPT 27275), spine manipulation (CPT 22505), ankle (CPT 27860), elbow (CPT 24300), and wrist (CPT 25259)—is explicitly not covered under this policy.
If your practice bills MUA for any joint outside those three, you're heading toward a claim denial.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna |
| Policy | Manipulation Under General Anesthesia |
| Policy Code | CPB 0204 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Orthopedic surgery, oral/maxillofacial surgery, anesthesiology, physical medicine & rehabilitation |
| Key Action | Audit all MUA claims against the three covered indications before billing; pull any claim using CPT 27275, 22505, 27860, 24300, or 25259 for MUA |
Aetna Manipulation Under General Anesthesia Coverage Criteria and Medical Necessity Requirements 2025
The Aetna MUA coverage policy under CPB 0204 is narrow by design. Aetna considers MUA medically necessary only for three specific indications. Each one has clinical guardrails attached.
Indication 1: Arthrofibrosis of the knee. This applies when arthrofibrosis follows total knee arthroplasty, knee surgery, or fracture. The relevant ICD-10 codes are M24.661 through M24.669 (ankylosis of knee joint). CPT 27570 is the procedure code for knee joint manipulation under general anesthesia. Your documentation needs to establish that the stiffness is a direct consequence of prior surgery or fracture—not just idiopathic joint stiffness.
Indication 2: Chronic, refractory frozen shoulder (adhesive capsulitis). This one has an important imaging caveat. Aetna covers CPT 23700 only if X-rays do not show bone pathology that explains the loss of motion. ICD-10 codes M75.0, M75.1, and M75.2 apply here. If your patient has radiographic findings—rotator cuff tear arthropathy, significant glenohumeral arthritis—Aetna will argue the loss of motion has a structural cause and deny the procedure.
Indication 3: Temporomandibular joint disorders. CPT 21073 covers therapeutic TMJ manipulation requiring anesthesia. ICD-10 codes M26.601 through M26.69 capture the relevant TMJ diagnoses, along with jaw fracture codes S02.400 through S02.69x and jaw dislocation codes S03.00xA through S03.02xS.
For all three indications, the phrase "chronic, refractory" is doing real work. Aetna expects documentation that conservative treatment has failed. That means physical therapy records, prior injection notes, and a clear clinical narrative explaining why general anesthesia is required rather than local or moderate sedation.
Whether Aetna requires prior authorization for these procedures depends on the member's specific plan. Check the member's benefits before scheduling. Don't assume that meeting the medical necessity criteria means the claim will pay without prior auth.
Aetna MUA Exclusions and Non-Covered Indications
This is where the policy gets blunt. Aetna explicitly lists joint procedures that are not covered under CPB 0204 for MUA indications. These aren't gray areas—they're black and white denials waiting to happen.
The not-covered CPT codes include:
| # | Excluded Procedure |
|---|---|
| 1 | CPT 24300 — Manipulation, elbow, under anesthesia |
| 2 | CPT 25259 — Manipulation, wrist, under anesthesia |
| 3 | CPT 26340 — Manipulation, finger joint, under anesthesia |
| 4 | CPT 26341 — Manipulation of palmar fascial cord post enzyme injection (Dupuytren's) |
| 5 | CPT 27198 — Closed treatment of posterior pelvic ring fracture/dislocation |
| 6 | CPT 27275 — Manipulation, hip joint, requiring general anesthesia |
| 7 | CPT 27860 — Manipulation of ankle under general anesthesia |
| 8 | CPT 22505 — Manipulation of spine requiring anesthesia, any region |
The spine exclusion is worth flagging separately. CPT 22505 covers spinal manipulation under anesthesia—a procedure some pain management and chiropractic medicine practices bill regularly. Aetna does not cover it under this policy for the indications listed in CPB 0204. If you're billing CPT 22505 for Aetna members, pull those claims and review them now.
The Dupuytren's code (CPT 26341) is also notable. This involves manipulation after collagenase injection. The related HCPCS code J0775 (collagenase clostridium histolyticum, 0.01 mg injection) appears in the policy as a related code—but the manipulation itself is not covered under this CPB.
Coverage Indications at a Glance
| Indication | Status | Primary CPT | ICD-10 Codes | Notes |
|---|---|---|---|---|
| Arthrofibrosis of knee following TKA, surgery, or fracture | Covered | 27570 | M24.661–M24.669 | Must be post-operative or post-fracture; document prior procedure |
| Chronic, refractory frozen shoulder (adhesive capsulitis) | Covered | 23700 | M75.0, M75.1, M75.2 | X-rays must not show bone pathology explaining motion loss |
| Temporomandibular joint disorders | Covered | 21073 | M26.601–M26.69; S02.400–S02.69x; S03.00xA–S03.02xS | Requires anesthesia service; document failure of conservative care |
| Hip joint manipulation under anesthesia | Not Covered | 27275 | — | Explicitly excluded under CPB 0204 |
| Spinal manipulation under anesthesia | Not Covered | 22505 | — | Any spinal region; explicitly excluded |
| Elbow manipulation under anesthesia | Not Covered | 24300 | — | Explicitly excluded |
| Wrist manipulation under anesthesia | Not Covered | 25259 | — | Explicitly excluded |
| Finger joint manipulation under anesthesia | Not Covered | 26340 | — | Explicitly excluded |
| Dupuytren's cord manipulation post enzyme injection | Not Covered | 26341 | — | J0775 (collagenase) listed as related but manipulation not covered |
| Ankle manipulation under anesthesia | Not Covered | 27860 | — | Explicitly excluded |
| Posterior pelvic ring fracture treatment | Not Covered | 27198 | — | Explicitly excluded |
Aetna MUA Billing Guidelines and Action Items 2025
The effective date of September 26, 2025 is already here. If your team hasn't audited MUA billing against this policy, start today.
| # | Action Item |
|---|---|
| 1 | Pull all MUA claims from the past 90 days. Check every claim against the three covered indications. If you've billed CPT 27275, 22505, 27860, 24300, or 25259 for Aetna members and tied it to an MUA indication, flag those for review immediately. |
| 2 | Update your charge capture to block non-covered MUA codes for Aetna. Your practice management system should throw an alert when a billing team member attempts to submit CPT 22505 or CPT 27275 for an Aetna member under an MUA indication. Build that logic in now. |
| 3 | Review frozen shoulder documentation before submitting CPT 23700 claims. Every case needs pre-procedure X-ray reports in the record. The report needs to explicitly state no bone pathology explains the motion loss. If it doesn't, get an addendum or a radiology re-read before billing. |
| 4 | Confirm prior authorization requirements at the plan level. CPB 0204 defines medical necessity, but prior authorization rules vary by member plan. Check the member's specific benefits for CPT 21073, 23700, and 27570 before the procedure date. A claim denial for missing prior auth is avoidable. |
| 5 | Document "chronic" and "refractory" with specificity. The words appear in the policy but Aetna's claim reviewers will look for clinical evidence. List conservative treatments attempted, duration, outcomes, and the clinical rationale for choosing general anesthesia over moderate sedation. Sparse documentation on MUA claims is the fastest path to a medical necessity denial. |
| 6 | Loop in your compliance officer if you bill MUA for Aetna across multiple joint types. If your orthopedic or anesthesia practice has been billing CPT 22505 or CPT 27275 for Aetna members, the exposure from unbundling or incorrect indications could be significant. Get a billing consultant to review your MUA coding patterns against CPB 0204 before your next claim cycle. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Manipulation Under General Anesthesia Under CPB 0204
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 21073 | CPT | Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service |
| 23700 | CPT | Manipulation under anesthesia, shoulder joint, including application of fixation apparatus |
| 27570 | CPT | Manipulation of knee joint under general anesthesia (includes application of traction or other fixation apparatus) |
Not Covered CPT Codes Under CPB 0204 Indications
| Code | Type | Description |
|---|---|---|
| 22505 | CPT | Manipulation of spine requiring anesthesia, any region |
| 24300 | CPT | Manipulation, elbow, under anesthesia |
| 25259 | CPT | Manipulation, wrist, under anesthesia |
| 26340 | CPT | Manipulation, finger joint, under anesthesia, each joint |
| 26341 | CPT | Manipulation, palmar fascial cord (Dupuytren's cord), post enzyme injection (e.g., collagenase) |
| 27198 | CPT | Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation |
| 27275 | CPT | Manipulation, hip joint, requiring general anesthesia |
| 27860 | CPT | Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) |
Anesthesia CPT Codes (Related to CPB 0204)
| Code | Type | Description |
|---|---|---|
| 00170 | CPT | Anesthesia for intraoral procedures, including biopsy; not otherwise specified |
| 00190 | CPT | Anesthesia for procedures on facial bones or skull; not otherwise specified |
| 00600 | CPT | Anesthesia for procedures on cervical spine and cord; not otherwise specified |
| 00604 | CPT | Anesthesia for procedures on cervical spine and cord; patient in sitting position |
| 00620 | CPT | Anesthesia for procedures on thoracic spine and cord, not otherwise specified |
| 00625 | CPT | Anesthesia for procedures on thoracic spine and cord, anterior transthoracic approach; not otherwise specified |
| 00626 | CPT | Anesthesia for procedures on thoracic spine and cord, anterior transthoracic approach; utilization of controlled hypotensive technique |
| 00630 | CPT | Anesthesia for procedures in lumbar region; not otherwise specified |
| 00632 | CPT | Anesthesia for procedures in lumbar region; lumbar sympathectomy |
| 00635 | CPT | Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture |
| 00640 | CPT | Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic, or lumbar spine |
| 00670 | CPT | Anesthesia for extensive spine and spinal cord procedures |
| 01160 | CPT | Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint |
| 01170 | CPT | Anesthesia for open procedures involving symphysis pubis or sacroiliac joint |
| 01200 | CPT | Anesthesia for procedures on bony pelvis |
| 01202 | CPT | Anesthesia for arthroscopic procedures of hip joint |
| 01220 | CPT | Anesthesia for all closed procedures involving upper two-thirds of femur |
| 01250 | CPT | Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg |
| 01320 | CPT | Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area |
| 01380 | CPT | Anesthesia for all closed procedures on knee joint |
| 01382 | CPT | Anesthesia for diagnostic arthroscopic procedures of knee joint |
| 01390 | CPT | Anesthesia for all closed procedures on upper ends of tibia, fibula, and/or patella |
| 01462 | CPT | Anesthesia for all closed procedures on lower leg, ankle, and foot |
| 01464 | CPT | Anesthesia for arthroscopic procedures of ankle and/or foot |
| 01470 | CPT | Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified |
| 01610 | CPT | Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla |
| 01620 | CPT | Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint |
| 01622 | CPT | Anesthesia for diagnostic arthroscopic procedures of shoulder joint |
| 01630 | CPT | Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint |
| 01710 | CPT | Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; not otherwise specified |
| 01730 | CPT | Anesthesia for all closed procedures on humerus and elbow |
| 01732 | CPT | Anesthesia for diagnostic arthroscopic procedures of elbow joint |
| 01740 | CPT | Anesthesia for open or surgical arthroscopic procedures of the elbow; not otherwise specified |
| 01810 | CPT | Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand |
| 01820 | CPT | Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones |
| 01829 | CPT | Anesthesia for diagnostic arthroscopic procedures on the wrist |
| 01830 | CPT | Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand |
| 01999 | CPT | Unlisted anesthesia procedure(s) |
| 99152 | CPT | Moderate sedation services provided by the same physician or other qualified health care professional; initial 15 minutes |
| +99153 | CPT | Moderate sedation services; each additional 15 minutes (add-on) |
| 99156 | CPT | Moderate sedation services provided by a different physician or qualified health care professional; initial 15 minutes |
| +99157 | CPT | Moderate sedation services by different provider; each additional 15 minutes (add-on) |
HCPCS Codes (Related to CPB 0204)
| Code | Type | Description |
|---|---|---|
| J0775 | HCPCS | Injection, collagenase, clostridium histolyticum, 0.01 mg |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| M24.661–M24.669 | Ankylosis of joint, knee (arthrofibrosis following total knee arthroplasty) |
| M26.601–M26.69 | Temporomandibular joint disorders |
| M75.0 | Adhesive capsulitis of shoulder (covered only if X-rays do not show bone pathology explaining motion loss) |
| M75.1 | Adhesive capsulitis of shoulder (covered only if X-rays do not show bone pathology explaining motion loss) |
| M75.2 | Adhesive capsulitis of shoulder (covered only if X-rays do not show bone pathology explaining motion loss) |
| S02.400–S02.413 | Fracture of malar, maxillary and zygoma bones; LeFort fracture |
| S02.600–S02.69x | Fracture of mandible |
| S03.00xA–S03.02xS | Dislocation of jaw |
| S72.401–S72.499 | Fracture of lower end of femur |
| S79.101–S79.199 | Unspecified physeal fracture of lower end of femur |
| S82.001–S82.099 | Fracture of patella |
| S82.101–S82.156 | Fracture of upper end of tibia |
| S82.191–S82.199 | Other fracture of upper end of tibia |
| S82.401–S82.499 | Fracture of fibula |
| M00.011–M24.659 | Musculoskeletal diseases NOT listed as covered under CPB 0204 |
| M24.671–M26.59 | Musculoskeletal diseases NOT listed as covered under CPB 0204 |
| M26.70–M72.9 | Musculoskeletal diseases NOT listed as covered under CPB 0204 |
| M75.100–M99.9 | Musculoskeletal diseases NOT listed as covered under CPB 0204 |
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