Aetna modified CPB 0397 covering knee ligament arthrometer testing, effective September 26, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated Clinical Policy Bulletin 0397, which governs its knee ligament arthrometer testing coverage policy. The modification affects how claims tie to a cluster of surgical and diagnostic codes — including CPT 95851, 97750, 27405, 27407, 27409, 27427, 27428, 27429, 29888, and 29889. If your practice bills for knee ligament repair, reconstruction, or related diagnostic testing under Aetna, this update changes your documentation and claim submission picture for 2025 and beyond.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Knee Ligament Arthrometer Testing |
| Policy Code | CPB 0397 Aetna |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium |
| Specialties Affected | Orthopedic surgery, sports medicine, physical medicine & rehabilitation, physical therapy |
| Key Action | Audit all claims pairing diagnostic testing codes (CPT 95851, 97750) with knee ligament surgical codes before billing Aetna on or after September 26, 2025 |
Aetna Knee Ligament Arthrometer Testing Coverage Criteria and Medical Necessity Requirements 2025
The core structure of CPB 0397 splits the affected codes into two distinct groups. That split is the real story here.
Aetna treats CPT 95851 (range of motion measurements and report) and CPT 97750 (physical performance test or measurement with written report) as not covered for the indications listed in this bulletin. That's a clear signal: if you're billing these codes in the context of knee ligament arthrometer testing, Aetna's coverage policy does not support reimbursement. Don't expect the claim to pay. Expect a claim denial.
The second group — CPT 27405, 27407, 27409, 27427, 27428, 27429, 29888, and 29889 — is listed as "other CPT codes related to the CPB." These are the knee ligament repair and reconstruction codes. They're included because arthrometer testing often appears in clinical workflows alongside these surgical procedures. Knowing whether Aetna considers arthrometer testing medically necessary affects how you document and bill the full episode of care.
Medical necessity documentation is the pressure point here. Aetna's coverage policy for this bulletin draws a hard line on diagnostic testing codes. If your providers use arthrometer testing — measuring anterior cruciate or posterior cruciate ligament laxity with a device like the KT-1000 — and then bill CPT 95851 or 97750 to capture that work, those codes fall outside Aetna's covered indications under CPB 0397. The question of prior authorization doesn't change this outcome. Even with prior auth in hand, a code listed as non-covered for specified indications won't cross to a paid claim based on authorization alone.
Talk to your compliance officer if your practice uses arthrometer testing routinely before or after ACL or PCL reconstruction. The interaction between the surgical codes and the excluded diagnostic codes creates real financial exposure.
Aetna Knee Ligament Arthrometer Testing Exclusions and Non-Covered Indications
Two codes sit firmly in non-covered territory under this coverage policy.
CPT 95851 covers range of motion measurements and report for each extremity excluding the hand. In a knee ligament context, this gets billed when a provider measures joint mobility as part of evaluating ligament integrity or surgical outcomes. Aetna's CPB 0397 does not cover this for the indications listed in the bulletin.
CPT 97750 covers physical performance tests or measurements — including musculoskeletal and functional capacity evaluations — with a written report. Arthrometer testing arguably fits the description of a physical performance measurement. Aetna's position is that it doesn't qualify for reimbursement under this policy's indications.
The real issue here is that both of these codes are commonly billed by physical therapists, physiatrists, and orthopedic practices as standalone or companion charges to surgical episodes. If your billing team treats them as routine add-ons to knee ligament surgery claims against Aetna, you're generating denials that your denial management team has to chase.
This isn't ambiguous. The policy categorizes these codes as "CPT codes not covered for indications listed in the CPB." That language is definitive.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Knee ligament arthrometer testing — range of motion measurement | Not Covered | CPT 95851 | Explicitly excluded for indications in CPB 0397; expect claim denial |
| Knee ligament arthrometer testing — physical performance measurement | Not Covered | CPT 97750 | Excluded for indications in CPB 0397; written report does not change coverage status |
| Primary repair of torn collateral ligament/capsule, knee | Related — Coverage per policy terms | CPT 27405 | Included as a related code; medical necessity documentation required |
| Primary repair of cruciate ligament, knee | Related — Coverage per policy terms | CPT 27407 | Included as a related code |
| Primary repair of collateral and cruciate ligaments, knee | Related — Coverage per policy terms | CPT 27409 | Included as a related code |
| Ligamentous reconstruction, extra-articular | Related — Coverage per policy terms | CPT 27427 | Included as a related code |
| Ligamentous reconstruction, intra-articular (open) | Related — Coverage per policy terms | CPT 27428 | Included as a related code |
| Ligamentous reconstruction, intra-articular and extra-articular | Related — Coverage per policy terms | CPT 27429 | Included as a related code |
| Arthroscopically aided ACL repair/augmentation or reconstruction | Related — Coverage per policy terms | CPT 29888 | High-volume code — verify documentation standards against this bulletin |
| Arthroscopically aided PCL repair/augmentation or reconstruction | Related — Coverage per policy terms | CPT 29889 | Included as a related code |
Aetna Knee Ligament Arthrometer Testing Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Remove CPT 95851 and 97750 from your Aetna charge capture templates for knee ligament testing before September 26, 2025. These codes are not covered for the indications listed in CPB 0397. Billing them against Aetna for arthrometer testing generates automatic denials. Flag this in your practice management system now. |
| 2 | Audit claims already submitted to Aetna that pair CPT 95851 or 97750 with any of the surgical codes in this bulletin. Look at claims from the past 12 months. If you've been billing these diagnostic codes as companion charges to CPT 29888 or 29889 (the arthroscopically aided ACL and PCL procedures), identify the denial rate and assess whether your team has been writing off legitimate denials instead of correcting the root cause. |
| 3 | Update your billing guidelines and coder education materials to reflect the CPB 0397 non-covered designation. Coders billing sports medicine or orthopedic surgery need to know that arthrometer testing billed under CPT 97750 or 95851 will not pay under this Aetna coverage policy. This is a training issue as much as a coding issue. |
| 4 | Verify documentation for the related surgical codes — CPT 27405, 27407, 27409, 27427, 27428, 27429, 29888, and 29889 — before the effective date of September 26, 2025. These codes are "related" to the bulletin, not excluded. But their connection to a modified policy means Aetna may scrutinize the full claim. Make sure operative reports and clinical notes clearly support medical necessity independent of any arthrometer testing rationale. |
| 5 | Check your prior authorization workflows for knee ligament procedures. Prior auth for the surgical codes in this bulletin isn't going away — but adding non-covered diagnostic codes to an authorized claim still results in partial denial. Authorization covers the procedure, not the billing errors around it. Confirm your prior auth requests don't include CPT 95851 or 97750 as line items under Aetna. |
| 6 | Talk to your compliance officer if arthrometer testing is a meaningful part of your clinical protocol for ACL or PCL evaluation. If your surgeons rely on KT-1000 or similar device measurements to make surgical decisions, and your practice has been billing for that testing, you need a clean strategy before September 26, 2025. The options are to absorb the cost, reclassify it within the encounter, or challenge coverage on a case-by-case basis with strong medical necessity documentation — but that last path is slow and resource-intensive. |
| 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 Knee Ligament Arthrometer Testing Under CPB 0397
Not Covered CPT Codes (For Indications Listed in CPB 0397)
| Code | Type | Description |
|---|---|---|
| 95851 | CPT | Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section |
| 97750 | CPT | Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report |
Other CPT Codes Related to CPB 0397
These codes are referenced in the bulletin as related to the policy. They are the primary surgical codes for knee ligament repair and reconstruction. Knee ligament arthrometer testing billing often appears in the same episode of care as these procedures.
| Code | Type | Description |
|---|---|---|
| 27405 | CPT | Repair, primary, torn ligament and/or capsule, knee; collateral |
| 27407 | CPT | Repair, primary, torn ligament and/or capsule, knee; cruciate |
| 27409 | CPT | Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments |
| 27427 | CPT | Ligamentous reconstruction (augmentation), knee; extra-articular |
| 27428 | CPT | Ligamentous reconstruction (augmentation), knee; intra-articular (open) |
| 27429 | CPT | Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular |
| 29888 | CPT | Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction |
| 29889 | CPT | Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction |
No HCPCS Level II codes or ICD-10-CM diagnosis codes are listed in the CPB 0397 policy data.
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