CMM-314: Hip Surgery-Arthroscopic and Open Procedures

Covered: arthroscopic/open hip surgery is allowed for acute fractures/malunions, tumor/infection/foreign body or deformity causing progressive destruction, synovial biopsy, irrigation/debridement for infection, removal of radiographically‑confirmed loose bodies, labral pathology, FAI, and selected AVN procedures per specified staging; procedures not listed (e.g., capsular plication, AIIS/subspinous decompression, in‑office diagnostic arthroscopy) and any other indications are considered experimental/investigational and not covered. Key requirements: documentation of clinical–imaging correlation and advanced imaging confirming pathology; labral/FAI candidates must have ≥3 months of provider‑directed non‑surgical care including an image‑guided intraarticular injection without a positive response and FAI must have Tönnis 0–1 only; AVN procedures require specific MRI/x‑ray staging and lesion‑size/location criteria (e.g., Ficat/Arlet ≤II or <30% involvement for core decompression).