CMM-313: Hip Replacement/ Arthroplasty

Covered: hip resurfacing, partial (hemi) and total hip arthroplasty, revisions, isolated head/liner exchange and salvage procedures when criteria are met; excluded for active local/systemic infection, skeletal immaturity, inadequate bone stock, severe immunocompromise, Charcot joint, and when osteonecrosis involves >50% of the femoral head for resurfacing (among other listed contraindications). Key requirements: documented function‑limiting hip pain and loss of function interfering with ADLs/employment, appropriate imaging/Tönnis or osteonecrosis staging, failure of ≥3 months of provider‑directed non‑surgical management (≥6 months if BMI >40), age ≤64 for resurfacing, and complete medical record documentation of indications and prior conservative care.

"Total hip resurfacing arthroplasty is considered medically necessary when ALL of the following criteria have been met: Failure of at least three (3) months of provider-directed non-surgical managem..."