CMM-313: Hip Replacement/Arthroplasty

Covered: partial and total hip resurfacing (resurfacing limited to patients ≤64 years), partial and total hip replacement, revision procedures, isolated head/polyethylene liner exchange (IPE), and salvage procedures when performed for specified diagnoses; resurfacing and replacements are not medically necessary for other indications or when exclusions are present (e.g., AVN >50% involvement, osteoarthritis affecting both femoral head and acetabulum for partial resurfacing, skeletal immaturity, active local/systemic infection, severe vascular/neuromuscular compromise, Charcot joint, and total resurfacing excluded in dialysis patients). Key requirements: documented weight-bearing radiographs/Tönnis grade or AVN extent/collapse, function‑limiting pain and loss of function generally ≥3 months with failure of provider‑directed non‑surgical management for ≥3 months (or clear documentation why non‑surgical care is inappropriate), plus implant status and clinical justification for revisions/IPE/salvage.