Billing and Coding: Total Hip Arthroplasty

Coverage is allowed for total hip arthroplasty only when the medical record documents medical necessity for Medicare Part A and Part B; services will be denied if documentation does not establish necessity. Required documentation includes a history and physical, discharge summary, physician progress notes and operative report, plus imaging (X‑ray/MRI/CT) demonstrating objective hip joint disease (e.g., subchondral cysts or sclerosis, osteophytes, subluxation, joint space narrowing, avascular necrosis, or bone‑on‑bone) and documented hip pain or functional disability (e.g., interference with ADLs).