Does Aetna require prior authorization for CPT 29881?

Yes. Aetna requires prior authorization for CPT 29881 (Arthroscopy, knee, surgical; with meniscectomy) under Standard commercial plans per its published clinical policy.

What documentation does Aetna require for CPT 29881?

Weight-bearing knee X-rays or MRI; Physical therapy records (12+ weeks); Medication history (NSAIDs/analgesics)

How much does Medicare pay for CPT 29881 in 2026?

In 2026, the national Medicare allowable for CPT 29881 is $515.71 in an office setting and $515.71 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.

What if Aetna denies the PA for CPT 29881?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Aetna Prior Authorization for CPT 29881

Arthroscopy, knee, surgical; with meniscectomy · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified April 8, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

Clinical criteria

Aetna CPB: Prior authorization required. Criteria: failed conservative treatment (NSAIDs >= 3 weeks or corticosteroid injection), physical therapy or home exercise (>= 12 weeks), activity modification (>= 12 weeks). Imaging must show the abnormality for which surgery is requested.

Documentation checklist

✓Weight-bearing knee X-rays or MRI
✓Physical therapy records (12+ weeks)
✓Medication history (NSAIDs/analgesics)

2026 Medicare rate for CPT 29881

Office (non-facility)

$515.71

Facility

$515.71

Total RVUs (office)

15.44

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Aetna's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 29881 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Weight-bearing knee X-rays or MRI, Physical therapy records (12+ weeks), Medication history (NSAIDs/analgesics).
3Submit via the payer's provider portal or designated PA channel.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Aetna require prior authorization for CPT 29881?: Yes. Aetna requires prior authorization for CPT 29881 (Arthroscopy, knee, surgical; with meniscectomy) under Standard commercial plans per its published clinical policy.
What documentation does Aetna require for CPT 29881?: Weight-bearing knee X-rays or MRI; Physical therapy records (12+ weeks); Medication history (NSAIDs/analgesics)
How much does Medicare pay for CPT 29881 in 2026?: In 2026, the national Medicare allowable for CPT 29881 is $515.71 in an office setting and $515.71 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.
What if Aetna denies the PA for CPT 29881?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other Aetna PA lookups

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