CG-SURG-11 Surgical Treatment for Dupuytren's Contracture

This policy addresses surgical treatment of Dupuytren’s contracture (e.g., palmar fasciotomy or fasciectomy). It is medically necessary when a palpable palmar cord is documented to impair function and any of the following are present: PIP or DIP contracture ≥20°, MCP contracture ≥20°, or symptomatic disease (pain, tenderness, or functional impairment). It is not medically necessary when these criteria are not met.

"Surgical treatment for Dupuytren’s contracture is consideredmedically necessarywhen a palpable palmar cord has been documented to impair the individual’s functional activitiesandany of the foll..."

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