29871
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.52
Facility
$491.33
Non-Facility
$491.33
Documentation Required
- 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"
Key Coverage Criteria
- 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
5 Active Policies
A54061 — Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees
UHC-POL-surgery-knee — Surgery of the Knee
UMR-POL-UMR-surgery-knee — Surgery of the Knee
SUREST-POL-SUREST-surgery-knee — Surgery of the Knee
AETNA-CPB-0673 — Osteoarthritis of the Knee: Selected Treatments
Related Codes
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