29999
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Medicare contractors may require operative notes, reports of standing x-rays, and/or arthroscopy results to define the patient’s knee condition when adjudicating coverage.
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- A valid ICD-10-CM diagnosis code that best describes the patient's condition must be submitted on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
- An Advance Beneficiary Notice of Noncoverage (ABN) may be used for outpatient services likely to be non-covered; follow CMS Claims Processing Manual Chapter 30 guidance when issuing ABNs.
Key Coverage Criteria
- Arthroscopic lavage or arthroscopic debridement for osteoarthritic knee in patients WITHOUT severe osteoarthritis who present with mechanical symptoms (eg, locking, snapping, popping), abnormal limb/knee alignment, or less severe/early degenerative arthritis may be considered for coverage at the discretion of the Medicare contractor.
- Surgery of the hip and surgical treatment for Femoroacetabular Impingement (FAI) Syndrome is proven and medically necessary in certain circumstances.
- For medical necessity clinical coverage criteria, refer to the InterQual® CP: Procedures: Arthroscopy, Diagnostic, +/- Synovial Biopsy, Hip; Arthroscopy, Surgical, Hip; Arthroscopy, Surgical, Hip (Pediatric); Arthrotomy, Hip; Hemiarthroplasty, Hip; Removal and Replacement, Total Joint Replacement (TJR), Hip; Total Joint Replacement (TJR), Hip.
- Surgical treatment for Femoroacetabular Impingement (FAI) Syndrome (including procedures such as arthroscopy with femoroplasty (29914), acetabuloplasty (29915), labral repair (29916), and related hip arthroscopy/arthroplasty procedures) when clinical criteria for medical necessity are met as defined by the referenced InterQual® criteria.
- InterQual® CP: Procedures - Arthroscopy or Arthroscopically Assisted Surgery, Shoulder (Adolescent) (used as the medical necessity clinical coverage criteria).
- Surgery of the shoulder is proven and medically necessary in certain circumstances.
18 Active Policies
A52369 — Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee Medical Policy Article
J06
A53435 — Billing and Coding: Thermal Capsulorrhaphy
CARELON-joint-surgery-2024-11-17-updated-2025-01-01 — Joint Surgery
UHC-POL-surgery-hip — Surgery of the Hip
UHC-POL-surgery-shoulder
Related Codes
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