Osseointegration for Lower and Upper Limbs (CPB 1045, reviewed 2026-01-20)

Effective immediately (2026-01-20): (1) Billing team must update Aetna claim denial logic to automatically deny all claims for osseointegration surgery, OPRA Implant System, Axor II connection device, and HCPCS code L5991 with denial reason 'Experimental/Investigational/Unproven.' (2) Update provider communication materials and billing guides to clearly state that osseointegration for limbs is not covered by Aetna. (3) Front desk and authorization staff must be trained to inform patients and providers upfront that this procedure is non-covered to prevent claim denials and patient financial liability. (4) Providers must document in the medical record that Standard Written Orders (SWO) requirements per DME MAC policy apply if any related osseointegrated prosthetic components are submitted; claims without completed SWO will be denied. (5) Verify that billing software reflects that CPT codes for osseointegration surgery and HCPCS codes for osseoanchored prostheses are not covered. Failure to implement denial rules will result in improper claims processing and potential overpayments.