Knee Arthroplasty

Aetna covers FDA‑approved total knee arthroplasty for adults with advanced knee joint disease — defined by pain/functional disability interfering with ADLs from OA, RA, avascular necrosis, or post‑traumatic arthritis plus physical findings (limited ROM, crepitus or effusion) and radiographic evidence of moderate‑to‑severe OA (Kellgren‑Lawrence grade 3–4) or avascular necrosis of the tibial/femoral condyle. TKA is not medically necessary if any absolute contraindication exists, including active joint infection or unresolved systemic bacteremia, active skin infection or open wound at the surgical site (except recurrent cutaneous Staphylococcus infections), vascular insufficiency, severe muscle atrophy or neuromuscular disease (including quadriplegia) compromising implant stability/recovery, inadequate bone stock, or allergy to implant components.

"Any pre-operative imaging or tests required to support the chosen (non-experimental) procedure as indicated in the medical record (e."