Does 29871 require prior authorization?

No, 29871 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 29871?

Medicare facility rate: $491.33. Non-facility rate: $491.33. Work RVU: 6.52.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

6.52

Facility

$491.33

Non-Facility

$491.33

Claims for arthroscopic lavage/drainage for infection should be billed using CPT 29871 and reference NCD 150.9.
Policy cites NCD 150.9 and CMS Change Request 3281; any additional documentation or contractor-specific requirements are determined by the Medicare contractor.
Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage; refer to the protocol titled Medical Records Documentation Used for Reviews
Updated imaging documentation requirement: "complete diagnostic interpretation of imaging findings including, at a minimum: relevant clinical information, detailed report of imaging findings, impression, and specialty(ies) of the provider(s) who interpreted the images"

All other indications for arthroscopic lavage of the knee are subject to Medicare contractor discretion.
Arthroscopic lavage and drainage of the knee for infection (septic arthritis) is covered and described by CPT 29871 per NCD 150.9.
Surgery of the knee is proven and medically necessary in certain circumstances (see InterQual® CP: Procedures).
Refer to InterQual® CP: Arthroscopy or Arthroscopically Assisted Surgery, Knee
Refer to InterQual® CP: Arthroscopy or Arthroscopically Assisted Surgery, Knee (Pediatric)
Refer to InterQual® CP: Arthroscopy, Diagnostic, +/- Synovial Biopsy, Knee

A54061 — Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees

CARELON-joint-surgery-2024-11-17-updated-2025-01-01 — Joint Surgery

CARELON-level-of-care-for-surgical-procedures-2025-11-15 — Level of Care for Surgical Procedures

UHC-POL-surgery-knee — Surgery of the Knee

UMR-POL-UMR-surgery-knee

Ask Verity about documentation requirements, denial risks, or coverage in your state.