CMM-314: Hip Surgery-Arthroscopic and Open Procedures

Covered: arthroscopic or open hip surgery is medically necessary for acute fractures/malunions, tumor/infection/foreign body causing progressive destruction, removal of radiographically confirmed loose bodies, synovial biopsy/debridement, labral repair/reconstruction, FAI procedures, specified AVN procedures, and synovectomy for listed inflammatory/degenerative diagnoses; excluded are cases with Tönnis grade ≥2, joint space narrowing <2 mm, severe version/gait abnormalities, many other non-listed indications, and procedures deemed experimental/investigational (e.g., capsular plication, AIIS/subspinous decompression, in‑office diagnostic arthroscopy). Key requirements: documentation correlating exam and advanced imaging, radiographic confirmation for FAI/loose bodies, documented Tönnis grade 0 or 1 (and absence of grades 2–3) for labral/FAI, failure of ≥3 months provider‑directed non‑surgical management (must include an image‑guided intra‑articular hip injection with local anesthetic ± corticosteroid), and procedure‑specific imaging/staging criteria for AVN and synovectomy.