Aetna Prior Authorization for CPT 27130
Total hip arthroplasty in OH
Documents Needed
- Weight-bearing hip X-rays or advanced imaging
- Physical therapy records (12+ weeks)
- Medication history (NSAIDs/analgesics)
Clinical Criteria
Aetna CPB: Prior authorization required for total hip arthroplasty. Criteria: advanced joint disease on imaging, failed conservative treatment including medication trial and physical therapy (>= 12 weeks). Documentation must include imaging interpretation with clinical findings.
Source: Aetna Precertification Lists 2026 (Participating Provider + Behavioral Health)
Submission Tips
Document medical necessity thoroughly before submitting. Include clinical notes, relevant test results, and a clear rationale for why CPT 27130 is appropriate for the patient's condition.
About CPT 27130
CPT 27130 — Total hip arthroplasty. Prior authorization requirements vary by payer, plan type, and state. Aetna requires prior authorization for this procedure in OH.
Have a question about CPT 27130?
Ask D3FreeCPT 27130 with Other Payers
Medical Billing Disclaimer
The information provided on this page is for educational and informational purposes only. While we strive to maintain the most current and accurate prior authorization data, requirements change frequently and vary by individual plan type. Always verify prior authorization requirements directly with the payer before performing a procedure. D3rx is not responsible for any claim denials or reimbursement issues.