CMM-313: Hip Replacement/ Arthroplasty

Partial and total hip resurfacing, partial and total hip arthroplasty, revision arthroplasty, isolated head and polyethylene liner exchange, and salvage procedures are medically necessary when specified indications are met — typically function‑limiting hip pain interfering with ADLs for ≥3 months (≥6 months if BMI>40) with documented failure of provider‑directed non‑surgical care, appropriate imaging (weight‑bearing radiographs, osteonecrosis staging/Tönnis grade), age ≤64 for resurfacing, or specific fracture/infection/time‑window criteria (e.g., IPE for eccentric wear with well‑fixed implants or infection <4 weeks; revisions for dislocation, instability, loosening, infection, fracture or unexplained pain >6 months). Procedures are excluded for active local/systemic infection, skeletal immaturity, osteonecrosis >50% of the femoral head, inadequate bone stock, severe uncontrolled comorbidities or immunocompromise, Charcot joint, significant vascular or neuromuscular compromise, and other listed contraindications, and full documentation of symptoms, imaging, prior treatments, and rationale is required.