Hip Arthroplasty - Medicare Advantage

This policy covers hip arthroplasty procedures—including total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA), partial HRA, and related revisions—for patients with end‑stage hip joint disease (eg, damaged femoral head/acetabular cartilage) and inflammatory arthritis. Coverage is limited by Medicare/NCD/LCD medical‑necessity criteria (eg, LCD L34163 and other MAC LCDs), generally requires viable proximal femoral bone and, for HRA, typically younger active patients (often <65), references only FDA‑approved resurfacing systems, and is subject to member contract terms and MAC geographic jurisdiction.

"Policies in this document may be modified by a member's coverage document (member contract may supersede policy)."

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