27301
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.61
Facility
$484.98
Non-Facility
$720.12
Documentation Required
- None specified in this document chunk. (The chunk contains general policy statement only; no explicit documentation requirements provided.)
- Refer to CMS Medicare Coverage Database and applicable CMS Online Manual System (IOMs) and Transmittals for current documentation requirements.
- Refer to the applicable MAC's Local Coverage Article (LCA) for specific documentation requirements, as Humana applies the MAC's LCA to requests within the MAC's jurisdiction.
- Related Humana policies referenced (may contain additional documentation/coverage criteria): 'Allograft Transplantation of the Knee' and 'Osteochondral and Subchondral Defects Surgery'.
Key Coverage Criteria
- Lavage for intra-articular infections.
- Ligamentum teres injury.
- Microfracture.
- Pathological synovial disease (eg, synovectomy).
- Loose intra-articular body
- Scapulothoracic bursitis (snapping scapula syndrome)
1 Active Policy
HUMANA-HIP-KNEE-AND-SHOULDER-ARTHROSCOPIC-SURGERIES-MA — Hip, Knee and Shoulder Arthroscopic Surgeries - Medicare Advantage
Related Codes
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