CMM-314: Hip Surgery-Arthroscopic and Open Procedures

Arthroscopic or open hip surgery is covered for acute fractures, malunions, tumor/infection/foreign body/deformity causing progressive destruction, synovial biopsy, septic irrigation/debridement, removal of radiographically confirmed loose bodies, labral repair/reconstruction and FAI when strict clinical and radiographic criteria are met, AVN procedures with procedure-specific imaging, and synovectomy for specified inflammatory/structural synovial diseases; exclusions include patients with Tönnis grade 2–3 or other specified adverse radiographic findings (e.g., joint space narrowing <2 mm, broken Shenton line), and procedures deemed experimental (e.g., capsular plication, anterior inferior iliac spine decompression, in‑office diagnostic arthroscopy). Key requirements: documentation correlating exam and advanced imaging, failure of ≥3 months of provider‑directed non‑surgical care that MUST include an image‑guided intra‑articular hip injection without meaningful relief, explicit Tönnis grade 0–1 for labral/FAI cases, and procedure‑specific imaging criteria for AVN and synovectomy per MS‑4/MS‑24.