Does G0289 require prior authorization?

No, G0289 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0289?

Medicare facility rate: $72.81. Non-facility rate: $72.81. Work RVU: 1.44.

Verity

`G0289` — Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

1.44

Facility

$72.81

Non-Facility

$72.81

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.

Physician/provider is responsible for identifying patients for whom Medicare does not consider the procedure reasonable or necessary and must report appropriate procedure codes: CPT 29999 for arthroscopic lavage of the knee for OA and/or arthroscopic debridement and lavage for severe OA; CPT 29877 for arthroscopic debridement/chondroplasty for knee pain only or debridement without lavage for severe OA; HCPCS G0289 for removal of loose body/foreign body/chondroplasty at time of other surgical knee arthroscopy in a different compartment.

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.
Arthroscopic debridement (with or without partial meniscectomy) for persons presenting with mild-to-moderate (Outerbridge classification I and II, not III or IV) osteoarthritis (OA) with knee pain plus mechanical symptoms due to loose bodies and/or meniscal tears;
Arthroscopic partial meniscectomy for traumatic meniscal tears unless there is moderate or severe osteoarthritis present (Outerbridge classification III or IV);
Intra-articular glucocorticoid injections for the treatment of knee OA.
CPT/HCPCS/ICD-10 codes listed as "covered if selection criteria are met": e.g., CPT 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body), G0289, CPTs 29880/29881 for arthroscopic partial meniscectomy, ICD-10 M17.0–M17.9 (Osteoarthritis of knee), M23.000–M23.369 (Derangement of meniscus due to old tear or injury), M25.561–M25.569 (Pain in knee), M25.661–M25.669 (Stiffness of knee), Q68.6 (Discoid meniscus) — when the CPB selection criteria are met.
Moderate-to-severe knee pain with radiographically confirmed knee OA (Kellgren-Lawrence (KL) grade II/III).

3 Active Policies

A52369 — Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee Medical Policy Article

J06

AETNA-CPB-0673 — Osteoarthritis of the Knee: Selected Treatments

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

`G0289` — Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

G0289 — Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`G0289` — Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee