Femoro-Acetabular Surgery for Hip Impingement Syndrome — CPB 0736 | AETNA Coverage Update

Aetna modified CPB 0736 for femoro-acetabular surgery (hip impingement syndrome), effective January 16, 2026. Here's what changes for billing teams.

Aetna, a CVS Health company, updated this coverage policy to tighten the medical necessity criteria for both open and arthroscopic femoro-acetabular surgery. The revision directly affects CPT codes 29914, 29915, 29916, 29861, 29863, and related osteotomy codes (27146, 27147, 27151, 27156). If your practice bills for hip arthroscopy or FAI surgery under Aetna plans, review your prior authorization workflows and documentation requirements now — before claims go out under the updated policy.

---

Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Femoro-Acetabular Surgery for Hip Impingement Syndrome
Policy Code	CPB 0736
Change Type	Modified
Effective Date	January 16, 2026
Impact Level	High
Specialties Affected	Orthopedic Surgery, Sports Medicine, Hip Surgery, Physical Medicine & Rehabilitation
Key Action	Audit documentation for all eight medical necessity criteria before submitting claims — especially the conservative treatment timeline and imaging thresholds

---

Aetna Hip Impingement Surgery Coverage Criteria and Medical Necessity Requirements 2026

The real issue with the CPB 0736 Aetna system update is the specificity of the criteria stack. This isn't a single-gate policy. To get femoro-acetabular surgery covered — open or arthroscopic — your patient must clear eight distinct criteria, and Aetna requires all of them.

Criterion 1: Imaging-confirmed FAI with labral pathology.
X-ray, MRI, or CT must show labral pathology (partial or full thickness labral tearing or labral damage) plus at least one of the following structural findings:

#	Covered Indication Copy
1	Cam impingement with alpha angle greater than 50 degrees
2	Pincer impingement (acetabular retroversion or coxa profunda) with center edge angle ≥ 40 degrees
3	Pistol grip deformity (non-spherical femoral head shape)

That alpha angle threshold matters. Make sure the imaging report explicitly documents the measurement — not just a clinical impression of "cam morphology."

Criterion 2: Moderate to severe symptoms for at least six months.
The patient must have hip or groin pain worsened by flexion activities (squatting, prolonged sitting) that significantly limits activities. The six-month duration clock doesn't start until the imaging-based FAI diagnosis is established.

Criterion 3: Positive impingement sign.
Documented sudden pain on 90-degree hip flexion with adduction and internal rotation, or extension and external rotation. This needs to be in the clinical notes — not implied.

Criterion 4: Failure of conservative treatment for at least 12 weeks.
This is where many prior authorization requests fail. The policy requires all of the following:

Read that again: virtual physical therapy does not satisfy the conservative treatment requirement. If your patient completed their PT via telehealth only, Aetna will deny the claim on that basis alone.

Criterion 5: No advanced osteoarthritis.
Pre-operative X-ray must show Tonnis grade less than 2. Tonnis grade 2 or higher is a hard exclusion. Outerbridge grade III or IV cartilage injury also disqualifies the patient.

Criterion 6: Adequate joint space.
Joint space must measure at least 2 mm anywhere along the sourcil on plain radiograph of the pelvis. Document this measurement explicitly in the pre-op workup.

Criterion 7: No generalized joint laxity or hypermobility syndromes.
Marfan syndrome and Ehlers-Danlos syndrome are explicitly excluded. If a patient has a documented hypermobility-related diagnosis, the surgery is not covered under this policy.

Criterion 8: No osteogenesis imperfecta.
A straightforward exclusion, but document it in the pre-authorization submission.

For labral tear repair specifically (CPT 29916), Aetna considers hip arthroscopy medically necessary for traumatic labral tears causing mechanical symptoms, or as an adjunct to FAI surgery.

---

Aetna Hip Impingement Surgery Exclusions and Non-Covered Indications

Several services are non-covered or bundled under this coverage policy, and billing them separately will generate a claim denial.

CPT 29860 — Diagnostic Hip Arthroscopy. Aetna considers this generally not medically necessary. Arthroscopy should only be performed when radiologically proven pathology already meets the criteria above. The one exception: if the surgeon proceeds to the OR with confirmed pathology on imaging but does not find the pathology intraoperatively, then 29860 may be billed for that session.

CPT 29862 — Debridement/chondroplasty during hip arthroscopy. Aetna considers this integral to FAI surgery and not separately reimbursable. Don't unbundle it.

Iliopsoas tendon release, capsular repair, and capsular release surgery. All considered integral to the primary procedure. Not separately reimbursable. This is the kind of bundling rule that surfaces as a denial months after the surgery — flag it in your charge capture workflow now.

Revision hip arthroscopy. Aetna acknowledges this may occasionally be necessary but treats it as a high-documentation case. You must submit documentation of why the prior surgery failed and why revision surgery meets the original FAI criteria. Don't submit a revision claim without a detailed surgical narrative.

Imaging disputes. If the operating surgeon disagrees with the official written report of a CT, MRI, or myelogram, the policy requires the surgeon to document the disagreement, discuss it with the interpreting provider, and obtain a written addendum to the official report. A surgeon's verbal disagreement with radiology findings — undocumented — won't support coverage.

---

Coverage Indications at a Glance

---

Aetna Hip Impingement Surgery Billing Guidelines and Action Items 2026

These are the specific steps your billing and coding teams need to take before submitting claims under the updated CPB 0736.

Copy Action Items

If your practice has a high volume of FAI cases and you're uncertain how this update applies to your patient mix, talk to your compliance officer before January 16, 2026. The eight-criterion gate is strict, and a documentation gap on any one criterion is enough to flip a covered claim to a denial.

---

CPT, HCPCS, and ICD-10 Codes for Femoro-Acetabular Surgery Under CPB 0736

Covered CPT Codes (When Selection Criteria Are Met)

Other CPT Codes Related to CPB 0736

These codes are listed in the policy as related codes. Coverage depends on indication, plan, and individual criteria — not blanket coverage.

HCPCS Code

Code	Type	Description Copy
S2115	HCPCS	Osteotomy, periacetabular, with internal fixation

Key ICD-10-CM Diagnosis Codes

The full policy lists 877 ICD-10-CM codes. The table below shows a representative sample of the hip-specific rheumatologic and structural codes most relevant to FAI billing. Confirm the complete list in the full policy at app.payerpolicy.org/p/aetna/0736.

---