CMM-313: Hip Replacement/ Arthroplasty

Covers hip arthroplasty (partial/total resurfacing and replacement), revisions, isolated head/liner exchange, and salvage procedures when procedure‑specific criteria are met—generally function‑limiting pain ≥3 months (≥6 months if BMI>40), loss of hip function affecting ADLs/employment, appropriate radiographic evidence (weight‑bearing x‑rays/Tönnis grade or documented osteonecrosis extent), and other specific indications (e.g., age ≤64 for resurfacing; revision/IPE for dislocation, aseptic loosening, infection, fracture, instability, osteolysis, or elevated metal levels). Excluded for contraindications such as active local/systemic infection, inadequate bone stock, osteonecrosis >50%, skeletal immaturity, severe/uncontrolled comorbidities or immunocompromise (and other listed exclusions), and requires documentation of non‑surgical treatment duration/type, imaging/lab findings, and risk/benefit justification if non‑surgical care is not appropriate.

"Partial hip resurfacing arthroplasty is NOT medically necessary for osseous abnormalities that cannot be optimally managed prior to surgery which would increase likelihood of poor outcome (inadequa..."